title: Evaluation of appropriateness of patient transfers for hand and microsurgery to a level I trauma center.
abstract: BACKGROUND
  The transfer of patients for hand and microsurgical emergencies to level I trauma centers is a common practice. Many of these transfers do not actually require a hand specialist and could be taken care of at most regional hospitals. In this study, we will evaluate the appropriateness of patient transfers for hand trauma and determine if there is a correlation between inappropriate transfers and undesirable factors, such as insurance status and off-hour's presentation.
  
  
  METHODS
  A retrospective chart review was performed in all patients transferred to a level I trauma center for hand and microsurgical trauma over a 22-month period. Collected data included indication for transfer, mode of transfer, time and day of the week, patient demographics, insurance status, and whether the transferring facilities had surgical coverage available. A synopsis, including treatment details, of each transfer was created, and a survey was sent to a review committee who rated the appropriateness of the transfers. Statistical analysis was performed to determine whether appropriateness of transfers was influenced by nonmedical variables.
  
  
  RESULTS
  Over a 22-month period, a total of 95 hand or microsurgical patients were transferred to a single tertiary referral center. Of these, 66 % of the transfers were considered inappropriate by the surveyed physicians. Inappropriate transfers were statistically more likely to be under insured or transferred during nonbusiness hours.
  
  
  CONCLUSIONS
  A large percentage of patients are being transferred to tertiary care centers for reasons other than medical necessity, generating a large burden on already strained medical resources.
authors.affiliation: Division of Hand Surgery, Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, 1200 E. Broad St., West Hospital, 9th Floor, 23298 Richmond, VA USA.
authors.forename: Ilvy
authors.initials: I
authors.lastname: Friebe
authors.affiliation: Division of Hand Surgery, Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, 1200 E. Broad St., West Hospital, 9th Floor, 23298 Richmond, VA USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Isaacs
authors.affiliation: Division of Hand Surgery, Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, 1200 E. Broad St., West Hospital, 9th Floor, 23298 Richmond, VA USA.
authors.forename: Satya
authors.initials: S
authors.lastname: Mallu
authors.affiliation: Division of Hand Surgery, Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, 1200 E. Broad St., West Hospital, 9th Floor, 23298 Richmond, VA USA.
authors.forename: Anton
authors.initials: A
authors.lastname: Kurdin
authors.affiliation: Division of Hand Surgery, Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, 1200 E. Broad St., West Hospital, 9th Floor, 23298 Richmond, VA USA.
authors.forename: Varatharaj
authors.initials: V
authors.lastname: Mounasamy
authors.affiliation: Division of Hand Surgery, Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, 1200 E. Broad St., West Hospital, 9th Floor, 23298 Richmond, VA USA.
authors.forename: Harinder
authors.initials: H
authors.lastname: Dhindsa
keywords: EMTALA; Hand trauma; Microsurgery; Transfers