Large cost savings realized from the 2006 Field Triage Guideline: reduction in overtriage in U.S. trauma centers.
BACKGROUND
Ambulance transport of injured patients to the most appropriate medical care facility is an important decision. Trauma centers are designed and staffed to treat severely injured patients and are increasingly burdened by cases involving less-serious injury. Yet, a cost evaluation of the Field Triage national guideline has never been performed.


OBJECTIVE
To examine the potential cost savings associated with overtriage for the 1999 and 2006 versions of the Field Triage Guideline.


METHODS
Data from the National Hospital Ambulatory Medical Care Survey and the National Trauma Databank (NTDB) produced estimates of injury-related ambulatory transports and exposure to the Field Triage guideline. Case costs were approximated using a cost distribution curve of all cases found in the NTDB. A two-way sensitivity analysis was also used to determine the impact of data uncertainty on medical costs and the reduction in trauma center visits (12%) after implementation of the 2006 Field Triage guideline compared with the 1999 Field Triage guideline.


RESULTS
At a 40% overtriage rate, the average case cost was $16,434. The cost average of 44.2% reduction in case costs if patients were treated in a non-trauma center compared with a trauma center was found in the literature. Implementation of the 2006 Field Triage guideline produced a $7,264 cost savings per case, or an estimated annual national savings of $568,000,000.


CONCLUSIONS
Application of the 2006 Field Triage guideline helps emergency medical services personnel manage overtriage in trauma centers, which could result in a significant national cost savings.
National Center for Injury Prevention and Control, Division of Injury Response, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA. mfaul@cdc.gov
Mark
M
Faul
Marlena M
MM
Wald
Ernest E
EE
Sullivent
Scott M
SM
Sasser
Vikas
V
Kapil
E Brooke
EB
Lerner
Richard C
RC
Hunt
D000552:Ambulances / Q000191:economics / Q000592:standards; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D004632:Emergency Medical Services / Q000191:economics* / Q000592:standards*; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D014187:Transportation of Patients / Q000191:economics / Q000592:standards; D014193:Trauma Centers / Q000191:economics / Q000592:standards; D014218:Triage / Q000191:economics* / Q000592:standards*; D014481:United States