Financial Impacts of Unnecessary Transfers of Patients With Hand Injuries at a Level 1 Trauma Center

Area of Science:

• Trauma Surgery
• Health Economics
• Healthcare Management

Background:

• Unnecessary interfacility transfers for hand surgery evaluations incur substantial patient costs and deplete trauma center resources.
• The financial burden of these transfers on receiving institutions remains largely unquantified.
• This study aimed to assess the financial impact of non-indicated transfers at a Level 1 trauma center.

Purpose of the Study:

• To determine the financial impact of non-indicated patient transfers to a Level 1 trauma center for hand surgery evaluations.
• To analyze the costs, reimbursement, and net operating margin associated with unnecessary transfers.
• To evaluate the overall effect on the receiving institution's financial performance.

Main Methods:

• A retrospective review of 505 interfacility transfers to the emergency department from 2018-2023.
• Classification of transfers into 'necessary' and 'unnecessary' based on American Society for Surgery of the Hand guidelines.
• Analysis of direct/indirect costs, total reimbursement, and net operating margin for unnecessary transfers.

Main Results:

• 61% (309 patients) of transfers were deemed unnecessary.
• Unnecessarily transferred patients were more likely to be uninsured (23% vs. 15%) and often discharged from the ED (73%).
• The 5-year net operating margin from these transfers was -$2628, with commercial insurance yielding financial gains.

Conclusions:

• The overall financial impact of unnecessary hand surgery transfers on the tertiary referral center was not significant.
• Mitigating unnecessary transfers offers patient cost savings and improves emergency care resource utilization.
• The benefits of reducing unnecessary transfers likely exceed the minimal financial implications for receiving institutions.