title: The impact of true partnership between a university Level I trauma center and a community Level II trauma center on patient transfer practices.
abstract: OBJECTIVE
  To examine the effect of a clinical and administrative partnership with an academic urban Level I trauma center on the patient transfer practices at a suburban/rural Level II center.
  
  
  METHODS
  Data for 2 years before affiliation (PRE) abstracted from inpatient charts and the trauma registry were compared with that for 2 years after (POST). The following data were collected: number of, reason for, and destination and demographics of transfers. Chi(2) test and t test analyses were used; p < 0.05 defined significance; data are mean +/- SEM.
  
  
  RESULTS
  Transfer rate increased from 4% PRE to 6.9% (p = 0.001) POST with no significant difference in age, Glasgow Coma Scale score, Injury Severity Score, or Revised Trauma Score. Repatriation occurred in 12.8% POST (none PRE). The current Level I facility accepted 1.8% of all transfers PRE and 36.4% POST (p = 0.0001). PRE/POST rates by reason are as follows: pediatric, 14.6%/9.0% (p = 0.04); intensive care unit, 0.4%/1.7% (p = 0.13); complex orthopedic, 100%/0% (p = 0.005); vascular, 50%/0% (p = 0.008); spinal cord injury, 100%/100%; and ophthalmologic, 0%/100% (p = 0.005).
  
  
  CONCLUSIONS
  In this experience of Level I/II partnership (1) transfer patterns were altered, (2) select patient cohort transfers decreased (pediatric, complex orthopedic, vascular), whereas others increased (aortic work-up), and (3) repatriation rates were low.
authors.affiliation: University of Pennsylvania, Philadelphia, USA.
authors.forename: W
authors.initials: W
authors.lastname: Schwab
authors.forename: H L
authors.initials: HL
authors.lastname: Frankel
authors.forename: M F
authors.initials: MF
authors.lastname: Rotondo
authors.forename: D A
authors.initials: DA
authors.lastname: Gares
authors.forename: E A
authors.initials: EA
authors.lastname: Robison
authors.forename: R M
authors.initials: RM
authors.lastname: Haskell
authors.forename: W S
authors.initials: WS
authors.lastname: Hoff
authors.forename: D R
authors.initials: DR
authors.lastname: Kauder
authors.forename: J
authors.initials: J
authors.lastname: Thornton
mesh_terms: D006764:Hospitals, Community / Q000458:organization & administration* / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000458:organization & administration* / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D007373:Interinstitutional Relations; D010360:Patient Transfer / Q000706:statistics & numerical data*; D010414:Pennsylvania; D011785:Quality Assurance, Health Care; D012040:Regional Health Planning; D012042:Registries; D012189:Retrospective Studies; D014193:Trauma Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D015599:Trauma Severity Indices