THE IMPACT OF TRUE PARTNERSHIP BETWEEN A UNIVERSITY-LEVEL-I TRAUMA CENTER AND A COMMUNITY-LEVEL-II TRAUMA CENTER ON PATIENT TRANSFER PRACTICES

Objective: To examine the effect of a clinical and administrative part nership with an academic urban Level I trauma center on the patient tr ansfer practices at a suburban/rural Level III center. Methods: Data f or 2 years before affiliation (PRE) abstracted from inpatient charts a nd the trauma registry were compared with that for 2 years after (POST ). The following data were collected: number of, reason for, and desti nation and demographics of transfers. chi(2) test and t test analyses were used; p < 0.05 defined significance; data are mean +/- SEM. Resul ts: Transfer rate increased from 4% PRE to 6.9% (p = 0.001) POST with no significant difference in age, Glasgow Coma Scale score, Injury Sev erity Score, or Revised Trauma Score. Repatriation occurred in 12.8% P OST (none PRE). The current Level I facility accepted 1.8% of all tran sfers PRE and 36.4% POST (p = 0.0001). PRE/POST rates by reason are as follows: pediatric, 14.6%/9.0% (p = 0.01); intensive care unit, 0.4%/ 1.7% (p = 0.13); complex orthopedic, 100%/0% (p = 0.005); vascular, 50 %/0% (p = 0.008); spinal cord injury, 100%/100%; and ophthalmologic, 0 %/100% (p = 0.005). Conclusions: In this experience of Level I/II part nership (1) transfer patterns were altered, (2) select patient cohort transfers decreased (pediatric, complex orthopedic, vascular), whereas others increased (aortic work-up), and (3) repatriation rates were lo w.