Unnecessary Interfacility Transfers For Craniomaxillofacial Trauma
Matthew Pontell, M.D.1, Juan Colazo, B.Sc.2, Brian C. Drolet, M.D.1.
1Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA, 2Vanderbilt University School of Medicine, Nashville, TN, USA.
PURPOSE: Patients with CMF injuries are frequently transferred for specialist evaluation. Although transfer guidelines have improved outcomes for trauma care, no standards exist for CMF injuries. As a result, many patients are unnecessarily transferred emergently between facilities, resulting in high costs to patients and the healthcare system. This study assesses the regional frequency and necessity of transfers for isolated CMF injury.
METHODS: A retrospective review was conducted of all transfers with a diagnosis of ‘facial trauma’ from 2013-2018. Using a previously validated framework, emergency interfacility transfers were deemed either necessary or unnecessary.
RESULTS: A total of 368 transfers were identified with isolated CMF injuries. Only 27% of transfers required admission. Half of transfers were unnecessary, none of which required intervention by the facial trauma service. Of 49.5% of necessary transfers, 38% required admission for surgery or management of symptoms related to facial injury, 62% were discharged from the ED and three patients required emergency surgery.
CONCLUSION: Isolated CMF trauma rarely requires emergency surgery; however, transferred patients occasionally require urgent and elective procedures. Unnecessary transfers result in substantial expense to the patient and the health care system, and patients ultimately experience a delay in definitive care. Unnecessary patient evaluation diverts emergency staff and resources; increasing wait times and morbidity for other patients. This study demonstrates an opportunity for transfer guidelines to improve interfacility triage of patients with facial injury.
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