Researchers at Stanford University looked at more than 4,500 trauma cases at 636 hospitals around the country to see what happened to critically injured patients brought to emergency rooms that aren’t designated trauma centers. They found that non-trauma centers were much more likely to admit patients who had insurance, whether it was private insurance or Medicaid coverage, than to transfer them to more skilled facilities.
“It’s the opposite of the overly aggressive transfer of a poor patient,” said Dr. Arthur Kellermann, the dean of the U.S. Military Medical School, and a trauma care expert who was not involved in the study. “This is actually suggesting that patients who have coverage for critical injuries may not be getting transferred as quickly as they should be.”
Getting to a designated trauma center matters for patients with serious injuries. Severely injured patients are 25 percent less likely to die at a trauma center than in a typical emergency room. It’s not just a matter of getting in the door at the closest hospital, but getting in the door at the right hospital, Dr. Kellermann said. “That’s the whole point of trauma centers. The expertise, the speed of response, the capacity to manage complex injuries is significantly better at major trauma centers. That’s the whole reason certain hospitals are designated trauma centers.”
The business of medicine too often dictates where patients are cared for, said Kellermann, and that includes whether a hospital admits patients or transfers them. “That decision should not be influenced by economics one way or the other. It should be influenced only by what’s in the best interest of patients,” he said.
Read about this in Kaiser Health News on February 19, 2014.
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