Development of a statewide trauma system: classification of levels of care available to injured patients.
OBJECTIVE
To categorize the level of care offered in emergency settings at acute care hospitals in Kentucky.


METHODS
Survey mailed to all hospitals in the state.


RESULTS
Hospital capabilities for both adult and pediatric patients were assessed by strict adherence to a set of preset objective requirements and by a subjective review of the resources available to the acutely injured patient, based on the responses to a mailed questionnaire. There are three level 1 and nine level 2 hospitals available to adults and two level 1 and seven level 2 hospitals available to children in Kentucky. Thirty-five counties are without an acute care hospital. Objective- and subjective-based classification were discordant in approximately 25% of hospitals. Current referral patterns reflect this categorization, but referral is most often directly to level 1 centers.


CONCLUSIONS
We have established a set of criteria to categorize the level of care acutely available to injured patients in Kentucky which can be simply implemented. In developing statewide systems of care, strict adherence to preset criteria may not accurately reflect the true resources available. With the lack of a planned and organized system, current referral patterns reflect transfer of patients directly to level 1 centers, which may result in overtriage and underutilization of level 2 or level 3 hospitals.
Svenson
J E
JE
Department of Emergency Medicine, University of Kentucky, Lexington, USA.
Stapczynski
J S
JS
Nypaver
M
M
Calhoun
R
R
D000328:Adult; D002648:Child; D003625:Data Collection; D004632:Emergency Medical Services; D006801:Humans; D007629:Kentucky; D010360:Patient Transfer; D012017:Referral and Consultation; D012040:Regional Health Planning; D014193:Trauma Centers