Prolonged Emergency Department Stay at Referring Facilities: A Poor Trauma Performance Improvement Tool

Area of Science:

• Trauma surgery
• Emergency medicine
• Public health

Background:

• Delayed patient transfers may increase morbidity and mortality.
• Initiatives aim to reduce emergency department length of stay (LOS) at referring facilities (RF).
• Current performance improvement (PI) metrics using RF LOS >4 hours have limited improvement opportunities.

Purpose of the Study:

• To evaluate the impact of referring facility LOS on patient outcomes.
• To identify key variables for performance improvement in trauma patient transfers.
• To assess trends in mortality and hospital LOS over time.

Main Methods:

• Analysis of a statewide trauma registry (2013-2018).
• Inclusion of 13,721 nongeriatric adult transfer patients with ED LOS <12 hours.
• Use of descriptive and inferential statistics, including logistic regression, to analyze prehospital and RF data, vital signs (VS), Glasgow Coma Score-Motor component (GCS-M), mortality, hospital LOS (HLOS), and ICU LOS.

Main Results:

• Mortality decreased over time across all injury severity groups.
• Abnormal GCS-M and systolic blood pressure (SBP) were strongly correlated with mortality.
• Increased mortality related to RF LOS was observed only for abnormal SBP; abnormal SBP and GCS-M were associated with the longest HLOS and ICU LOS.

Conclusions:

• The >4-hour RF LOS metric for PI is not supported by the data.
• Improved survival is attributed to the timely transfer of high-risk patients.
• PI review should focus on transfer patients with abnormal GCS-M and SBP within a more focused timeframe.