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Factors associated with transfer of hand injuries to a level 1 trauma center: a descriptive analysis of 1147 cases.

Publication ,  Journal Article
Butala, P; Fisher, MD; Blueschke, G; Ruch, DS; Richard, MJ; Hollenbeck, ST; Levinson, H; Leversedge, FJ; Erdmann, D
Published in: Plast Reconstr Surg
April 2014

BACKGROUND: The transfer of patients with hand injuries involves a commitment of substantial resources, emphasizing the importance of understanding factors that may influence referral patterns. Anecdotal experience suggests that the likelihood of transfer increases during nights and weekends. This study aimed to analyze patterns of hand trauma transfers to Duke University Medical Center with respect to timing and patient insurance status. METHODS: The authors performed a retrospective chart review and analysis of 1147 consecutive patient transfers from 2005 to 2010 at a single level 1 university trauma center. Data categories included timing of transfer, patient demographics, insurance status, diagnosis, and procedures performed. Statistical analysis was performed using SAS software (SAS Institute Inc., Cary, N.C.). RESULTS: Of the patient sample, 39.8 percent was female, 30 percent were African American, and 57.3 percent were white. Contrary to our expectations, transfers were more likely during the day (p = 0.0001). Likewise, patients were more likely to present on weekdays than on weekends (p = .001). Although uninsured patients were not disproportionately represented overall, they were more frequently transferred at night (p = 0.0001), despite having the same complexity of injuries as privately insured patients. Conversely, patients with private insurance were less likely to be transferred at night (p = 0.0001). CONCLUSIONS: Similar to studies in other surgical specialties, this analysis demonstrates significant associations between insurance status and hand injury transfer patterns. The current climate, including declining numbers of surgeons willing to provide emergency hand care, diminishing reimbursements, and an expanding uninsured patient population, threatens to exacerbate these concerning trends in trauma patient management.

Duke Scholars

Published In

Plast Reconstr Surg

DOI

EISSN

1529-4242

Publication Date

April 2014

Volume

133

Issue

4

Start / End Page

842 / 848

Location

United States

Related Subject Headings

  • Trauma Centers
  • Surgery
  • Retrospective Studies
  • Patient Transfer
  • Medically Uninsured
  • Male
  • Insurance Coverage
  • Humans
  • Hand Injuries
  • Female
 

Citation

APA
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ICMJE
MLA
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Butala, P., Fisher, M. D., Blueschke, G., Ruch, D. S., Richard, M. J., Hollenbeck, S. T., … Erdmann, D. (2014). Factors associated with transfer of hand injuries to a level 1 trauma center: a descriptive analysis of 1147 cases. Plast Reconstr Surg, 133(4), 842–848. https://doi.org/10.1097/PRS.0000000000000017
Butala, Parag, Mark D. Fisher, Gert Blueschke, David S. Ruch, Marc J. Richard, Scott T. Hollenbeck, Howard Levinson, Fraser J. Leversedge, and Detlev Erdmann. “Factors associated with transfer of hand injuries to a level 1 trauma center: a descriptive analysis of 1147 cases.Plast Reconstr Surg 133, no. 4 (April 2014): 842–48. https://doi.org/10.1097/PRS.0000000000000017.
Butala P, Fisher MD, Blueschke G, Ruch DS, Richard MJ, Hollenbeck ST, et al. Factors associated with transfer of hand injuries to a level 1 trauma center: a descriptive analysis of 1147 cases. Plast Reconstr Surg. 2014 Apr;133(4):842–8.
Butala, Parag, et al. “Factors associated with transfer of hand injuries to a level 1 trauma center: a descriptive analysis of 1147 cases.Plast Reconstr Surg, vol. 133, no. 4, Apr. 2014, pp. 842–48. Pubmed, doi:10.1097/PRS.0000000000000017.
Butala P, Fisher MD, Blueschke G, Ruch DS, Richard MJ, Hollenbeck ST, Levinson H, Leversedge FJ, Erdmann D. Factors associated with transfer of hand injuries to a level 1 trauma center: a descriptive analysis of 1147 cases. Plast Reconstr Surg. 2014 Apr;133(4):842–848.

Published In

Plast Reconstr Surg

DOI

EISSN

1529-4242

Publication Date

April 2014

Volume

133

Issue

4

Start / End Page

842 / 848

Location

United States

Related Subject Headings

  • Trauma Centers
  • Surgery
  • Retrospective Studies
  • Patient Transfer
  • Medically Uninsured
  • Male
  • Insurance Coverage
  • Humans
  • Hand Injuries
  • Female