title: Factors associated with transfer of hand injuries to a level 1 trauma center: a descriptive analysis of 1147 cases.
abstract: BACKGROUND
  The transfer of patients with hand injuries involves a commitment of substantial resources, emphasizing the importance of understanding factors that may influence referral patterns. Anecdotal experience suggests that the likelihood of transfer increases during nights and weekends. This study aimed to analyze patterns of hand trauma transfers to Duke University Medical Center with respect to timing and patient insurance status.
  
  
  METHODS
  The authors performed a retrospective chart review and analysis of 1147 consecutive patient transfers from 2005 to 2010 at a single level 1 university trauma center. Data categories included timing of transfer, patient demographics, insurance status, diagnosis, and procedures performed. Statistical analysis was performed using SAS software (SAS Institute Inc., Cary, N.C.).
  
  
  RESULTS
  Of the patient sample, 39.8 percent was female, 30 percent were African American, and 57.3 percent were white. Contrary to our expectations, transfers were more likely during the day (p = 0.0001). Likewise, patients were more likely to present on weekdays than on weekends (p = .001). Although uninsured patients were not disproportionately represented overall, they were more frequently transferred at night (p = 0.0001), despite having the same complexity of injuries as privately insured patients. Conversely, patients with private insurance were less likely to be transferred at night (p = 0.0001).
  
  
  CONCLUSIONS
  Similar to studies in other surgical specialties, this analysis demonstrates significant associations between insurance status and hand injury transfer patterns. The current climate, including declining numbers of surgeons willing to provide emergency hand care, diminishing reimbursements, and an expanding uninsured patient population, threatens to exacerbate these concerning trends in trauma patient management.
authors.affiliation: Durham, N.C. From the Division of Plastic, Reconstructive, Maxillofacial, and Oral Surgery, and the Department of Orthopedics, Hand, and Upper Extremity Section, Duke University.
authors.forename: Parag
authors.initials: P
authors.lastname: Butala
authors.forename: Mark D
authors.initials: MD
authors.lastname: Fisher
authors.forename: Gert
authors.initials: G
authors.lastname: Blueschke
authors.forename: David S
authors.initials: DS
authors.lastname: Ruch
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Richard
authors.forename: Scott T
authors.initials: ST
authors.lastname: Hollenbeck
authors.forename: Howard
authors.initials: H
authors.lastname: Levinson
authors.forename: Fraser J
authors.initials: FJ
authors.lastname: Leversedge
authors.forename: Detlev
authors.initials: D
authors.lastname: Erdmann
mesh_terms: D000328:Adult; D005163:Factor Analysis, Statistical; D005260:Female; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D017057:Medically Uninsured; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014193:Trauma Centers