Expansion of Hand Trauma Transfers at a Level 1 Trauma Center Following Integration with the ASSH Hand Trauma Center Network.

Abstract

Purpose: This study sought to evaluate how joining the National Hand Trauma Center Network (NHTCN) affected the volume, demographics, and severity of hand trauma transfers to our institution.

Methods: Data for this study were collected retrospectively over a 6-year period from 2016 to 2021 from our institutional trauma registry. Patients were selected based on the criterion of being transferred to our facility because of isolated hand trauma. Analyses of transfer rates, transfer distance, sending facilities, injury patterns, insurance type, path of care, and hospital charges prior to and after joining the NHTCN were performed.

Results: There was a total of 39 transfers with isolated hand trauma over 3 years prior to joining the NHTCN, and 114 over 3 years after. The average number of hand transfers per year increased by 25, with an increase in both in-state and out-of-state transfers. This included an increase in transfers of serious injuries including complete amputations, open devascularization injuries, and open fractures. The average distance traveled by transfers increased by 22.6 miles. The demographics and insurance coverage of transfers were similar. The overall average charge per person increased from $23,885 to $33,663. Admissions of transfers decreased by 27.3%. The percentage of transfers undergoing surgery or receiving specialized hand care in the ED increased from 66.7% to 91.2%.

Conclusions: Integration into the NHTCN increased our institution's volume of hand trauma transfers, with patients transferred from additional referring facilities, some of which were further from our center.

Clinical relevance: These findings suggest that joining the NHTCN increased regional patient access to specialized hand surgical care. There was an overall increase in the quantity of severe injuries treated; however, there were only small shifts in the overall composition of transfers.