Interfacility transfers in a non-trauma system setting: an assessment of the Greek reality

Abstract

BackgroundQuality assessment of any trauma system involves the evaluation of the transferring patterns. This study aims to assess interfacility transfers in the absence of a formal trauma system setting and to estimate the benefits from implementing a more organized structure.MethodsThe 'Report of the Epidemiology and Management of Trauma in Greece' is a one year project of trauma patient reporting throughout the country. It provided data concerning the patterns of interfacility transfers. We compared the transferred patient group to the non transferred patient group. Information reviewed included patient and injury characteristics, need for an operation, Intensive Care Unit (ICU) admittance and mortality. Analysis employed descriptive statistics and Chi-square test. Interfacility transfers were then assessed according to each health care facility's availability of five requirements; Computed Tomography scanner, ICU, neurosurgeon, orthopedic and vascular surgeon.ResultsData on 8,524 patients were analyzed; 86.3% were treated at the same facility, whereas 13.7% were transferred. Transferred patients tended to be younger, male, and more severely injured than non transferred patients. Moreover, they were admitted to ICU more often, had a higher mortality rate but were less operated on compared to non transferred patients. The 34.3% of transfers was from facilities with none of the five requirements, whereas the 12.4% was from those with one requirement. Low level facilities, with up to three requirements transferred 43.2% of their transfer volume to units of equal resources.ConclusionTrauma management in Greece results in a high number of transfers. Patients are frequently transferred between low level facilities. Better coordination could lead to improved outcomes and less cost.

Advanced Trauma Life Support certified physicians in a non trauma system setting: Is it enough?

“…We recently published our data on emergency room management and in-hospital transfer patterns of trauma patients. 5,6 The overall mean time spent in the emergency department for trauma patients was 1 h and 28 min. In those trauma patients that were destined to either the ICU or the operating room, the time spent in the ER was 3 h and 41 min and 2 h respectively.…”

“…The study design and the main epidemiologic findings have been published recently. 5,6 In brief, approximately 40% of hospitals receiving trauma in Greece participated in the registry. The participating hospitals provide trauma care for approximately 40% of the country's residents.…”

Estudo epidemiológico do trauma ortopédico em um serviço público de emergência

“…As transferências representaram o segundo maior percentual de condição de saída hospitalar neste estudo, o que se justifica por se tratar de um hospital de urgência com uma elevada demanda de pacientes. Assim, quando é necessário um segundo tempo cirúrgico ou maiores recursos, parte dos pacientes internados é transferida para outras unidades hospitalares, desocupando os leitos para os quadros agudos 13,33 .…”

Evaluating trauma care, outcomes and costs in a system in crisis: the necessity of a Greek National Trauma Database

“…To date, there is no national trauma database in Greece. The annual epidemiology of trauma in our country can only be followed via police and emergency medical service (EMS) reports 4 5…”

“…The third level of healthcare consists of specialized centers and university hospitals which are primarily located in major cities. Secondary healthcare units may function like a level II, III or IV trauma center, whereas a tertiary unit has capabilities similar to a level I or II trauma center 4 5…”