Rural Hospital Transfer Patterns before and after Implementation of a Statewide Trauma System.

Area of Science:

• Emergency Medicine
• Trauma Surgery
• Health Systems Research

Background:

• Rural emergency departments (EDs) often face challenges in managing severe trauma.
• Effective trauma transfer protocols are crucial for optimizing patient outcomes.
• The implementation of a statewide trauma system aims to standardize and improve trauma care delivery.

Purpose of the Study:

• To assess the impact of a statewide trauma system on trauma transfer practices in rural Oregon.
• To compare trauma transfer patterns before and after the system's implementation.
• To identify changes in patient disposition from lower-level trauma facilities.

Main Methods:

• A historical control analysis comparing pre- and post-statewide trauma system implementation.
• Inclusion of rural ED trauma patients from Level-3 and Level-4 trauma hospitals.
• Review of medical records for specific index injuries over 3-year periods before and after system implementation.

Main Results:

• A significant increase in the proportion of ED trauma patients transferred from Level-4 hospitals (32% to 68%) post-implementation.
• A corresponding decrease in hospital admissions to Level-4 facilities (63% to 29%).
• Increased transfers from Level-4 to Level-2 facilities and from Level-3 to Level-1 centers, indicating a redistribution to higher-resource trauma hospitals.

Conclusions:

• The statewide trauma system effectively redistributed rural trauma patients.
• Patients were more likely to be transferred to trauma centers with greater therapeutic capabilities.
• The system demonstrated an independent positive impact on rural trauma patient transfer practices.