Diagnostic Accuracy and Appropriateness of Patients Transferred to a Level 1 Trauma Center for Hand Surgery Evaluation
Jyoti Sharma, MD; Suzanne Caroline Wilkens, MD; Kyle R. Eberlin, MD
Massachusetts General Hospital/Harvard Medical School, Boston, MA
Introduction: Regional hospitals are often not equipped to handle complex hand and upper extremity pathology, and patients are therefore often referred to tertiary care facilities for this reason. In our experience, the diagnosis at the time of referral is often incorrect, impacting the need for transfer and the overall cost of providing medical care. We aimed to study the appropriateness of the patients transferred to our institution. In addition, we were interested in the number of transfers outside of regular hours, trauma designation of the transferring hospitals and if our hospital was the closest level I trauma center for transfer.
Materials & Methods: All adult patients transferred to our level I trauma center for advanced care of hand and upper extremity injuries were included in this prospective study. From August 2016 till February 2017, we collected patient and injury related demographic information upon acceptance of transfer and arrival at our hospital. Patients transferred to other inpatient services or directly ER to ER without involvement of the hand surgery on call team were not included in this study.
Results: Thirty five patients were included. The majority of transfers (20/35) occurred either during the evening (6PM-6AM), during the weekend or holiday. Nine transferring hospitals (26%) had a closer level I trauma center than to our facility and 3 patients were directly transferred from another level I trauma center. For non-infection cases, 10/32 outside facilities had the wrong overall diagnosis; 4/10 injuries were under diagnosed and 6/10 over diagnosed. Out of the 35 transferred patients, 19 (54%) were taken to the operating room for a surgical procedure in an acute fashion and 7 (37%) of these patients required microsurgical intervention.
Conclusions: One out of 3 transferred patients had an incorrect diagnosis at the time of transfer from an outside hospital. The majority of transfers occurred outside of regular hours and only 54% of patients were in need of acute operative treatment. In addition, 26% of the referring hospitals had a closer level I trauma center than our facility. This suggests that regional microsurgery expertise is recognized and further establishment of designated microsurgery centers and formal referral guidelines may be beneficial for management of these difficult injuries.
Treatment at time of presentation to our center
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