Consequently, there are organized efforts to develop robust, collaborative trauma networks nationwide. Numerous studies have demonstrated implementing an organized system of trauma care can significantly reduce mortality of injured patients. Regional trauma systems are based on military models to provide timely and appropriate treatment of trauma patients. Severely injured and “high-risk” patient populations are commonly transferred from smaller hospitals with fewer resources to regional trauma centers for optimal care. Organized state and regional trauma systems have changed the delivery of care for injured patients. The perception trauma transfers increase institutional fiscal burden is unsubstantiated. These data suggest designated trauma centers should continue to encourage and accept appropriate transfer of trauma patients for surgical subspecialty care. Adult and Pediatric Trauma services accounted for 29 % ( n = 1674) of TTP versus 45 % of PTP ( n = 5045) discharges ( P < 0.0001). Patients were discharged predominantly by neurosurgery and orthopedic surgery (i.e.: General Adult and General Pediatric comprised <50 % of discharges) for all trauma admissions. Surprisingly 52 % of TTP were Medicare or HMO ( n = 3008) beneficiaries, versus 42 % of PTP being Medicare or HMO ( n = 4614) recipients ( P < 0.0001). Resultsĥ699 TTP and 11147 PTP were identified. Demographics, payor status, length of stay (LOS), injury severity score (ISS), and discharging service were compared. We queried our TC registry to identify trauma transfers (TTP) and primary trauma patients (PTP) treated at our level 1 TC between 20. Based on this observation, we hypothesized patients transferred from regional hospitals to Level 1 TCs would have lower injury severity scores (ISS) and unfavorable payor status. Trauma transfers frequently come during off hours and may not always appear to be related to injury severity.

By protocol, injured patients are preferentially transferred to designated TCs when a higher level of care is indicated. The regionalization of trauma care, the Emergency Medical Treatment and Active Labor Act of 1986, the advent of Accountable Care Organizations and bundled payments have brought Level 1 trauma centers (TC) to a new crossroads.

Trauma center levels graphic