Northwestern Study Identifies Barriers in Patient Transfers to Illinois Trauma Centers
By Amanda Dee
December, 16 2024
An emergency can strike anyone, anywhere, but only some hospitals are equipped to handle critically injured patients. Of these patients, 17 to 34 percent are first taken to the closest non-trauma specialized hospitals (1,2), where they must then wait to be transferred to a higher-level trauma center. Despite the fact that transfers within two hours greatly reduce mortality risk, hospital staff often face significant delays in these transfers, or retriages — double the recommended time on average (3,4) — leading to preventable deaths.
In the first study to address why these severely injured patients are not transported to trauma specialized hospitals as quickly as possible, Northwestern Medicine investigators identified a crucial need to improve inter-hospital transportation of patients as well as communication of their clinical information.
“In the hospital system, we’re more than just the sum of our parts,” said principal investigator Anne Stey, MD, assistant professor of Surgery at Northwestern University Feinberg School of Medicine and a member of the Institute for Public Health and Medicine. “How we work together in these spaces is really, really critical for actually saving people's lives.”
Improving inter-hospital coordination, the team specified, will require increased access to critical care ambulances and training of transport staff in addition to new mechanisms to exchange information, including radiology scans and estimated arrival times, between hospitals.
The cross-sectional study in Annals of Surgery surveyed nine high-level trauma hospitals and three high-level pediatric trauma centers in Illinois. Using a risk assessment tool called Failure Modes Effects Analysis (FMEA), the team spoke with 64 healthcare workers involved throughout the receiving end of the process to determine the most urgent areas for improvement.
In Stey and her team’s earlier study on the sending side of the process, the most urgent problems identified by non-trauma or lower-level trauma hospitals were a lack of clear and consistent criteria for which patients should be transferred and the inability to connect with higher-level trauma centers that would accept their patients.
“That there wasn't a little more synergy was surprising to me,” Stey added.
To begin to address these gaps as soon as possible, Stey’s team is developing a user-centered design manuscript for hospital staff. One solution that has already been introduced into the field is a bed tracker. During the height of COVID-19 hospitalizations, the Chicago Department of Public Health (CDPH) required hospitals to update the number of available beds twice per day. CDPH created a mechanism for hospitals to share their bed capacity data directly from the electronic health record, which could then be viewed on a shared dashboard. This tool would save valuable time and reduce human error compared to assigning the task to an already busy nurse or other healthcare worker.
“Initiatives like that are the types of things that can really make a big difference,” Stey emphasized. “If hospitals are willing to come together and collaborate more broadly around sharing the bed resources that they have available and prioritizing injured patients in particular, there is so much potential to save people from dying at small, non-trauma hospitals.”
The National Institutes of Health funded this study. The National Heart Lung and Blood Institute also funded this work (grant number K23HL157832).