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Overtriage of Trauma Patients Costly, On the Rise

Cheryl Clark, for HealthLeaders Media, September 17, 2010

The authors quantified the cost of secondary overtriage at $5,917 per case, "which is a significant burden considering the average healthcare-related expenditure per person per year in the United States is $8,047."

The paper also noted that many of the overtriaged patients, both adults and children, received CAT scans at the first hospital which "suggests a possible unfamiliarity with diagnostic scanning and interpretation at most hospitals when it comes to trauma patients."  In the future, telemedicine with remote radiology consults might solve the problem, "instead of physically sending the patients."

Michael Sise, MD, director of the Scripps Mercy Hospital trauma system in San Diego, acknowledges the problem as "a major issue in terms of the financial burden," and agrees that telemedicine might be part of the solution. Often, he says, the reason the referring hospital transfers the patient is because of a lack of specialists in neurosurgery, orthopedic surgery, and other specialty fields.  That doesn't mean the patients didn't need the transfer, he says.

He suggests that rather than deconstructing the trauma system, "we need to take a look at whether it's appropriate, and make sure we can access it for the patients who need it. If we're not going to transfer these patients, there ought to be some way to look at them (remotely) but that system doesn't currently exist."

The authors also found that patients who were rapidly discharged from the second facility were more likely to be male (68.3% versus 50.7%), more likely to be black or Hispanic, 25.2% vs 16.8%), more likely to come from ZIP codes with above-median household incomes (43.4% vs. 38.1%) more likely to be treated at urban hospitals (75.6% vs 66.3%) and more likely to e treated at teaching hospitals (74.9% vs 66.3%).

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