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Overtriage of Trauma Patients Costly, On the Rise

Cheryl Clark, for HealthLeaders Media, September 17, 2010

Health systems are increasingly "overtriaging" trauma patients, or unnecessarily transferring them to a different, often to a higher level, facility—an indication of the growing expense of unnecessary healthcare utilization and defensive medicine.

That's the finding from a University of California San Diego Health System researcher, whose report is published in the September issue of the Journal of Trauma. The researchers looked at 51,291 patients from the Nationwide Inpatient Sample from 2000 to 2004 who were originally classified as trauma patients. 

They were determined to have been overtriaged if they were sent home alive within 24 hours after their transfer to the second hospital and did not undergo any surgical procedure.

Among the study cohort, there were 3,291, or 6.9%, who were discharged after their transfer, a rate that has been increasingly steadily, the authors wrote, from 563 cases in 2000 to 980 cases in 2004.  Extrapolating this to the national population represents "2,685 in 2000 and 4,724 in 2004."

The authors wrote that their study "is the first attempt to examine the problem on a national scale," although one regional study in a young trauma system reported the overtriage rate at 38%.

Among those 20% of the pediatric trauma patients who were discharged one day after their transfer to a second facility, that transfer indicated "it was unlikely they needed to be transferred in the first place."

"This paper highlights the issue of defensive medicine," said David Chang, now director of UCSD's Center for Surgical Systems and Public Health.  "We found that pediatric patients (younger than age 18) are most prone to secondary overtriage, which may be due to physicians or hospitals being overly cautious for fear of legal repercussions."  Chang was at Johns Hopkins University when the report was prepared.

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