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Trauma centers blowing transfer deadlines 

Updated: September 24, 2012 6:25AM

Illinois hospitals that need to transfer trauma patients to facilities with higher levels of trauma care are supposed to do so within two hours.

But a new study finds that 80 percent of transfers made over a five-year period in Illinois exceeded the two-hour limit, though the most seriously injured patients did receive care within that window.

The findings, published Monday in the journal Archives of Surgery, call into question the need for mandating how quickly transfers between hospitals should take place, said study co-author Dr. Thomas J. Esposito, of Loyola University Chicago’s Stritch School of Medicine.

“Our theory is that that two-hour rule should be abandoned, and that emergency department physicians or trauma surgeons at the first hospital are smart enough without a rule to get the right patient to the right place in the right amount of time,” he said.

The reasons that hospitals may be missing the two-hour mark include late diagnosis of injuries and delays related to finding a specialist at another hospital who is available to treat the patient, Esposito said.

Trauma systems are built around the idea that minimizing the time it takes to get patients to the hospital best equipped to handle their injuries will improve outcomes.

The state’s administrative code sets a two-hour limit on transfers between trauma centers for patients needing more advanced care. But there are no formal penalties for failing to meet that benchmark, according to the Illinois Department of Public Health.

In what’s believed to be the first study on hospitals’ compliance with the rule, researchers from Loyola and Northwestern Medicine reviewed data from a state registry on more than 22,000 patient transfers that took place between 1999 and 2003, the most recent year for which data was available at the time.

Only 20 percent of transfers took place within the two-hour limit during that period. Even so, the most critically injured patients did make it to another hospital within two hours. And patients whose transfers took longer than that fared no worse on average than other trauma patients, researchers found.

A spokesman for the state health department, which sets standards for Illinois’ trauma system, wrote: “The data in the report is between seven and 10 years old, so the department would need newer data in order to comment on it.”

Though the data is several years old, Esposito said it’s unlikely that much has changed since 2003 that would have improved the timeliness of transfers.

Rather than imposing time limits for transfers, greater emphasis should be placed on regulating the conditions under which transfers occur to make sure high-level trauma centers aren’t being overburdened with cases that could be handled elsewhere, the study’s authors said.

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