Illinois law states that when hospitals need to transfer trauma patients to centers with higher levels of trauma care, such transfers should be made within 2 hours.
However, a new study, published in the Archives of Surgery, found that 80% of transfer cases took longer than 2 hours, though the most seriously injured patients did seem to more quickly reach the level of care that best met their medical needs within 2 hours.
“The 2-hour rule is only complied with 20% of the time,” Thomas Esposito, MD, trauma surgeon, chief of the Division of Trauma, Surgical Critical Care and Burns in the Department of Surgery at Loyola University Chicago Stritch School of Medicine and a co-author of the study, stated in a press release. “Eighty percent of the time the transfer occurs more than 2 hours after the arrival at the first hospital.”
The study examines data from the Illinois Trauma Registry from 1999 to 2003. During that period, 22,447 transfers of trauma patients occurred between facilities in the state, a transfer rate of 10.4%. Of those, 4,502 transfers (20%) took place within 2 hours. The median time for the remaining transfers was 2 hours and 21 minutes. The data cover 50% to 60% of transfer cases from 64 trauma centers in Illinois.
The study found that the patients who were transferred within 2 hours were more severely injured and more commonly underwent same-day surgery. These patients in the same set were more likely to die but the mortality rate for patients transferred after more than 2 hours matched those of all other trauma patients.
The patients most commonly transferred were those with head and orthopedic injuries, which could be due to shortages of medical specialists that treat those conditions, the study found. Also, self-paying patients were more likely to be transferred within 2 hours versus other same-day transfers or all other trauma patients.
“This seems to be an unfortunate national trend, not limited to Illinois, which represents a serious deficit in the emergency-care workforce, and that needs to be addressed,” Esposito stated. “Our theory is that that 2-hour directive should be abandoned and that emergency department physicians or trauma surgeons at the first hospital are smart enough without a rule to get the right patient to the right place in the right amount of time, That’s the mantra or the fundamental philosophy of trauma systems.”