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Rural Level III centers in an inclusive trauma system reduce the need for interfacility transfer.

Daniel J Galanis1, Susan Steinemann, Linda Rosen

  • 1From the Emergency Medical Services and Injury Prevention System Branch (D.J.G.), Hawaii State Department of Health, Honolulu, Hawaii; Department of Surgery, University of Hawaii John A. Burns School of Medicine and The Queen's Medical Center (S.S.), Honolulu, Hawaii; Department of Pediatrics (L.R.), University of Hawaii John A. Burns School of Medicine, Hawaii Health Systems Corporation, Honolulu, Hawaii; Emergency Medical Services and Injury Prevention System Branch (A.C.B.), Hawaii State Department of Health, Honolulu, Hawaii; and Trauma and Acute Care Surgery (W.B.), Scripps Memorial Hospital, La Jolla, California.

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Establishing rural Level III trauma centers significantly reduced patient transfers to higher-level facilities. This development improved trauma system efficiency without negatively impacting patient outcomes, including mortality or prolonged hospitalizations.

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Area of Science:

  • Trauma surgery
  • Health systems research
  • Emergency medicine

Background:

  • Regionalized trauma systems aim for efficient patient care through tiered centers.
  • Developing Level III trauma centers can potentially decrease interfacility transfers and resource strain.

Purpose of the Study:

  • To evaluate the impact of developing Level III trauma centers on patient transfer rates.
  • To assess if the designation of Level III centers affected patient morbidity and mortality.

Main Methods:

  • Analysis of state trauma registry data (2009-2015) from five rural hospitals.
  • Utilized multivariate logistic regression to control for patient demographics and injury severity.
  • Compared outcomes before (2009-2010) and after (2011-2015) Level III center designation.

Main Results:

  • A significant decrease in patient transfers was observed after Level III center designation (22% vs. 30%).
  • Adjusted odds of patient transfer were reduced by 32% post-designation (p < 0.0001).
  • No significant increase in mortality or prolonged hospitalizations (≥7 days) among non-transferred patients.

Conclusions:

  • Development of rural Level III trauma centers effectively reduces interfacility transfers within a regionalized system.
  • This strategy benefits patients, families, and the overall trauma system.
  • Patient outcomes were not adversely affected by the establishment of these centers.