Implementation of regional interfacility transfer guidelines for patients with isolated facial trauma: A preliminary...

Secondary overtriage (SO) of isolated craniomaxillofacial (CMF) fractures overwhelm trauma centers and represent a significant resource burden while ultimately delaying patient care. The objective of this study was to implement an interfacility transfer protocol at a tertiary level 1 trauma center and review the preliminary utilization findings.

A tertiary academic medical center adopted the protocol via the AgileMD pathway in regional referral centers. The protocol indicates the necessity of on-call specialist consultation based on a patient's clinical presentation. This study conducted a retrospective cohort analysis for patients with isolated CMF trauma and AgileMD pathway activation over a one year period. The main outcome was transfer center activation.

The pathway was utilized 55 times for isolated CMF trauma patients in one year. The majority of traumas involved nasal bone fractures (52.7%) and were most often caused by falls (49.1%). On-call specialist consultation occurred 18.2% of the time - down from 100% of cases prior to guideline institution. The majority of patients (78.2%) were discharged with 40.9% follow-up, while 16.4% were transferred. These dispositions followed the guidelines 90.9% of the time.

This is the first pilot study on the implementation of isolated CMF trauma interfacility transfer guidelines. The 81.8% reduction in on-call specialist consultation suggests a meaningful call burden reduction for surgical providers, while a discharge rate of 78.2% and outpatient follow-up rate consistent with pre-implementation levels reflects significant preservation of trauma resources. Broader adoption of similar protocols can further reduce SO, hospital costs, and wait times.