Secondary transfer of trauma patients: Rationale and characteristics

Background: Trauma systems were created in order to provide optimal care for trauma patients. Hence, patients transferred to level I trauma centers are assumed to be transferred due to medical reasons as a result of complex injuries. Objectives: To explore the reasons for transfer of patients from regional to level I trauma centers in Israel as a basis for establishing a national policy regarding transfers. Methods: The data on patients transferred to five level I trauma centers during a 6 month period were collected using a structured form. Results: The study population comprised 929 patients transferred from regional hospitals. Most transfers were due to the need for a specialty unavailable at the first hospital (65%) or for special diagnostic equipment (3% in Jews, 23% in Arabs). Only 3.6% of the transferred patients were transferred because of multi-system injury. Some casualties were transferred following their own request, 26% Jews and 3% Arabs. Conclusions: Most patient transfers concur with the recommendations of the Ministry of Health, namely, the absence of a certain specialty or equipment. The fact that many of the transfers reflect a lack of available resources at the first evacuation destination suggests that increasing the availability of these resources can help reduce secondary triage. It is recommended that a cost-benefit analysis be conducted.