Defining futile and potentially avoidable interhospital trauma transfers

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Healthcare Management

Background:

• Interhospital transfers (IHTs) to major trauma services reduce preventable deaths in critically injured patients.
• However, some transfers are futile or potentially avoidable, causing family distress, care delays, and resource strain.
• Characterizing these transfers is crucial for optimizing trauma care systems.

Purpose of the Study:

• To characterize futile and potentially avoidable interhospital trauma transfers (IHTs) based on current guidelines.
• To identify the frequency and patient demographics associated with these transfers.
• To inform strategies for reducing non-essential transfers and improving resource allocation.

Main Methods:

• Retrospective cohort study of adult patients transferred to a major trauma service (2016-2020).
• Defined futile IHTs as death or hospice transfer within 72 hours without intervention or ICU admission.
• Defined potentially avoidable IHTs as discharge without intervention or ICU care, including secondary over-triage.

Main Results:

• Seven (0.2%) of 2,837 IHTs were classified as futile, predominantly in elderly females with severe injuries (median ISS 16).
• 1,391 patients (49%) were potentially avoidable, with 513 (18%) classified as secondary over-triage (median age 43, median ISS 9).
• 70.7% of potentially avoidable IHTs were discharged directly home without tertiary intervention.

Conclusions:

• Futile interhospital trauma transfers are infrequent, but a significant proportion of transferred patients do not receive tertiary-level intervention.
• Developing systems like telehealth can support regional surgeons in co-managing lower-risk trauma, potentially reducing avoidable IHTs.
• Optimizing IHTs can decrease healthcare costs and resource utilization while maintaining high-quality trauma care and low mortality rates.