A COMPARISON OF TRANSFERRED VERSUS DIRECT ADMISSION ORTHOPEDIC TRAUMAPATIENTS

Trauma patients with orthopedic injuries transferred to Harborview Med ical Center (HMC) were compared with all trauma patients directly admi tted to HMC andwith a set of matched controls regarding Injury Severit y Score (ISS) and age,if greater than or equal to 50 years old. Groups were compared on ISS, Revised Trauma Score (RTS), ICU stay, length of stay (LOS), total charges, reimbursement, payers, and outcome. Compar ison of all transferred patients and directlyadmitted patients showed significant differences in ISS, LOS, ICU stay, and total charges. Desp ite a higher ISS, transferred patients had no differences inRTS or sur vival outcome. Comparison of matched transferred patients and directly admitted patients on ISS and age if greater than or equal to 50 years old showed a statistically significant increase in LOS, reimbursement , and charges. The survival rate of all transferred and directly admit ted trauma patients was approximately 95% for both groups despite a sl ightly higher degree of injury in transferred patients. The reimbursem ent rate for both groups was low, 65%for transferred patients and 59% for directly admitted patients. The percentage of transfer patients on Medicaid was 34% and for direct admissions was 37% (p = 0.552). This is a large percentage of indigent care, since only 8.1% of Washington State residents are Medicaid dependent.