Cameron O'Brien, Trevon Jelinek, Alec Young, Cole Phelps, Amar Patel, Clint Basener, Jeremy Scott
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Abstract
Objective: To evaluate the appropriateness, clinical outcomes, and cost burden of interfacility orthopaedic transfers to a Level III teaching hospital, and to assess adherence to institutional transfer protocols.
Design: Retrospective Cohort Study.
Setting: Level III teaching hospital in the Midwest United States.
Patients/participants: All patients referred for orthopaedic transfer between March 1, 2023, and May 31, 2024 (N = 267 transfers; 192 accepted, 73 denied).
Intervention: Not applicable. This was an observational study.
Main outcome measurements: Transfer appropriateness based on consultation timing, surgical intervention, and alignment with institutional protocols; secondary outcomes included transport distances, financial burden, and rate of secondary transfers.
Results: Most (77.6%) transfers were accepted by emergency medicine, with orthopaedic consultation requested in 80.9% of cases, but only 21.4% of these consultations occurred before initiation of the transfer. Approximately 50% of transferred patients required surgery, with an average time to surgery of 57.8 hours after their arrival at our Level III facility. The estimated transportation cost ranged from $502,507 to $573,707, with an additional hospital stay cost of $211,697.41. The total cost of transfers and care ranged from $714,204 to $785,404.
Conclusion: A substantial proportion of orthopaedic transfers to this Level III hospital were nonurgent, frequently lacked pretransfer orthopaedic consultation, and resulted in significant financial and resource burden. These findings highlight inefficiencies in current interfacility transfer practices and underscore the need for improved triage, communication, and adherence to existing transfer protocols. Further research is warranted to evaluate structured approaches aimed at improving transfer appropriateness and resource utilization.
Level of evidence: Level III, Retrospective Comparative Study.
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