Previous research shows that the risk that a patient will die in a trauma center is 25% less than if they are cared for in a non-trauma center, Delgado says. In effect, what his study found, he says, is that non-trauma hospitals are more likely to send uninsured patients to trauma centers where they get better care, than they are to send insured patients.
"It is a counterintuitive finding, and of course, 'dumping' is a harsh word to use. But maybe in this case, 'dumping' actually has an advantage for uninsured patients" whose transfers result in better care.
"While they may have the same resources on paper—neurosurgeons, orthopedic surgeons and intensivists—the hospitals designated as trauma centers go through an accreditation process with the American College of Surgeons or state committees. They've demonstrated that they not only have the people on paper, but they have the processes in place in order to optimize the care of these patients."
These vital elements include having key specialists immediately available and subspecialists available within 15 minutes. "They have quality improvement and teaching programs, and track their outcomes with registry data," Delgado says.
He adds, "A lot of the difference in outcomes is not just in the difference in initial management of the resuscitation, such as giving blood products, fluids, and managing the breathing, but also includes performing surgery, managing complications from the surgery, and the rehabilitation process, which are typically done better at trauma centers.