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Hand Surgery Transfers to Level 1 Center: Variables Affecting Transfer Method and Diagnostic Accuracy.

Jill Putnam¹, Rachel Pedreira¹, Paige Fox¹

¹Stanford University School of Medicine, Division of Plastic and Reconstructive Surgery, Stanford, Calif.

Plastic and Reconstructive Surgery. Global Open

|January 11, 2021

Summary

Many costly patient transfers for hand specialist care may be unnecessary. Over 30% of transfers could be managed locally, reducing costs and avoiding diagnostic errors in urgent transport.

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Area of Science:

Trauma Surgery
Hand Surgery
Health Economics

Background:

Patient transfers to specialized centers are common for hand injuries.
The cost-effectiveness and diagnostic accuracy of these transfers require evaluation.

Purpose of the Study:

To assess the cost-effectiveness of patient transfers to a level 1 trauma center for hand specialist management.
To identify factors influencing diagnostic accuracy and the necessity of transfers.

Main Methods:

Retrospective analysis of 265 patients transferred for hand surgery evaluation between 2014-2019.
Evaluation of patient/injury characteristics, consult time, transfer distance, provider level, transport method, cost, and diagnostic accuracy.

Main Results:

21% of pre-transfer diagnoses were inaccurate; flexor tenosynovitis and vascular injuries increased inaccuracy risk.
Air ambulance transport was significantly more expensive than ground transport.
Over 30% of transfers could have been managed at the transferring facility, indicating potential cost savings.

Conclusions:

A significant portion of transfers for hand conditions are potentially unnecessary, leading to increased costs.
Diagnostic errors and urgent transport risks are linked to specific diagnoses.
Provider education on transfer patterns can optimize resource utilization and patient care.