Evaluating trends among adult orthopaedic transfer volume and resource use

Understanding the demographics, time of day, day of the week, and specific characteristics of adult orthopaedic transfer patients may help to facilitate more efficient patient care.

Retrospective observational study.

Single center, academic, Level 1 trauma center in upstate New York.

Any adult patient (≥ 18 years old) from the transfer center database from 2016 to 2021 with musculoskeletal-related problems, as defined by ICD-10 codes, transferred from another facility to the emergency department.

Demographic information, disposition, transferring facility, type of injury, means of arrival, case mix index (CMI), and day/time of the week were tabulated and analyzed using descriptive statistics.

All 3763 adult patients that met selection criteria were included in the analysis. There was a 37% increase in adult orthopaedic transfers over the 5-year study period (558 in 2016 and 746 in 2021). The average CMI of transfers increased over the study span by 10.2%. Among all patients, 76.6% (n = 2882) were admitted to the hospital, with an average length of stay of 7.74 days and an average CMI of 2.16. Transferred patients with femur fractures had the highest CMI (2.47) followed by lower leg fractures (2.11). The most frequent time of arrival for orthopaedic transfers was the evening between the hours of 3:00 pm and 11:00 pm (53.9%) and on the weekend [P-value = 0.0049 comparing weekend to weekday].

The increase in transfers and CMI over the 5-year study period highlights the critical role tertiary centers play in the care of complex orthopaedic patients. The greater number of transfers during nonbusiness hours also suggests that referral centers may play an even greater role in the community during times when community orthopaedic services are not available.

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