title: Impact of level III verification on trauma admissions and transfer: comparisons of two rural hospitals.
abstract: OBJECTIVE
  To study the impact of Level III verification and other changes in rural hospitals on trauma delivery and to examine factors affecting transfer to a Level I trauma center.
  
  
  METHODS
  Two rural Kentucky hospitals and a Level I trauma center.
  Concurrent review of all trauma patients in 1988 and re-review of the same parameters in 1995.
  
  
  RESULTS
  In 1988, both hospitals had similar management practices in trauma care. A significant number of patients were transferred for (a) patient choice, (b) serious and/or multiple trauma, (c) specialty care in non-life threatening situations, and (d) to exclude a potentially serious problem seen on radiologic evaluation (usually questionable cervical spine or widened mediastinum). Both hospitals had major changes in trauma delivery. One hospital received Level III verification, and the other had changes that lessened the general surgeon's involvement with initial evaluation and treatment. A re-review in 1995 disclosed major changes at both institutions. Transfers to exclude radiologic abnormalities had virtually disappeared. The Level III status had increased the surgical involvement in that hospital; there was actually an increase in patients transferred to the Level I hospital and an increase in patient acuity. More operations were performed locally, and the care was more efficiently delivered. The other hospital had a large increase in transfers and decreased admissions locally as general surgical involvement decreased.
  
  
  CONCLUSIONS
  The factors related to patient transfer for trauma care are complex and require careful elucidation to improve care. The development of a Level III trauma service appeared to increase the number of seriously injured patients treated in the rural hospital and the efficiency of the care delivered.
authors.affiliation: Department of Surgery, University of Louisville School of Medicine, Kentucky 40292, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Richardson
authors.forename: T
authors.initials: T
authors.lastname: Cross
authors.forename: D
authors.initials: D
authors.lastname: Lee
authors.forename: E
authors.initials: E
authors.lastname: Shively
authors.forename: E
authors.initials: E
authors.lastname: Bentley
authors.forename: D
authors.initials: D
authors.lastname: Weiss
authors.forename: K
authors.initials: K
authors.lastname: Brock
authors.forename: J
authors.initials: J
authors.lastname: Petrocelli
authors.forename: F B
authors.initials: FB
authors.lastname: Miller
authors.forename: H C
authors.initials: HC
authors.lastname: Polk
mesh_terms: D003211:Concurrent Review; D006297:Health Services Accessibility; D006780:Hospitals, Rural; D006801:Humans; D015601:Injury Severity Score; D007629:Kentucky; D007902:Length of Stay; D008137:Longitudinal Studies; D010343:Patient Admission; D010360:Patient Transfer; D014947:Wounds and Injuries / Q000145:classification / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*