EMS field triage guidelines reduce major trauma hospital visits

Adherence to field triage guidelines can minimize the costs associated with sending low-risk injured patients to major trauma centers, according to study results recently published in Health Affairs.

From January 2006 through December 2008, researchers estimated hospital-level differences in the adjusted cost of acute care for injured patients transported by 94 emergency medical service (EMS) agencies to 122 hospitals in seven regions, overall and by injury severity. The seven regions included the metropolitan areas of Portland, Ore. and Vancouver, Wash.; Sacramento, Calif.; Santa Carla, Calif.; Salt Lake City; King County, Wash.; San Francisco; and Denver County, Colo.

According to study results, EMS transported more than 301,000 injured patients to hospitals; 248,342 were low-risk patients who should have not been taken to major trauma hospitals per the EMS national triage guidelines. However, 85,155 of the low-risk patients were in fact taken to a major trauma hospital, resulting in an estimated $136.7 million increased cost per year in the regions studied.

Study results also showed the average cost of care for a trauma patient at a Level 1 trauma hospital was $5,590 higher vs. a non-trauma hospital. The average per-patient cost at Level 1 trauma centers was $4,833 higher when restricted to patients with minor injuries, compared with non-trauma hospitals.

“What our study shows is there are huge cost implications in how EMS systems work to get injured patients to the appropriate hospitals,” Craig Newgard, MD, associate professor of emergency medicine at the Oregon Health & Science University Center for Policy and Research in emergency medicine, stated. “And it shows how very early decisions in the process of health care — even prior to a patient arriving at the hospital — can lead to much higher costs downstream for our health care system.”

For more information:

Newgard CD. doi: 10.1377/hlthaff.2012.1142.

Disclosure: The researchers report no relevant financial disclosures.

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