title: Indirect Referral of Orthopaedic Patients to a Safety-Net Hospital.
abstract: Patients seen in emergency departments (EDs) not requiring admission are typically discharged with appropriate follow-up. Sometimes hospitals indirectly refer, or redirect, patients to a different hospital's ED. Anecdotally, indirect referrals are commonly received in safety-net hospitals. This study characterizes the types of patients and hospitals affected and the cost of indirect referral in the orthopaedic trauma population.
  
  
  
  A retrospective cross-sectional chart review was conducted of 1,162 consecutive adult patients receiving orthopaedic care in an urban public hospital ED over a six-month period in 2011. Multivariable logistic regression analysis compared patients who were indirectly referred with those presenting primarily.
  
  
  
  One in five (N=236) patients treated for orthopaedic injury was indirectly referred from neighboring hospitals with orthopaedists available; 209 (88.6%) of these patients were uninsured (OR 3.69; CI 1.85-7.34). Nonprofit hospitals initially treated 107 (64.1%) of these patients. Costs for largely uncompensated care at the public hospital were $1.77 million.
authors.forename: Laura N
authors.initials: LN
authors.lastname: Medford-Davis
authors.forename: Michelle
authors.initials: M
authors.lastname: Phelps
authors.forename: Paul
authors.initials: P
authors.lastname: Hausknecht
authors.forename: Zachary F
authors.initials: ZF
authors.lastname: Meisel
authors.forename: Charles
authors.initials: C
authors.lastname: Reitman
authors.forename: Angela S
authors.initials: AS
authors.lastname: Fisher
mesh_terms: D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D009985:Orthopedics / Q000191:economics / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D064876:Safety-net Providers / Q000191:economics / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D017664:Uncompensated Care / Q000191:economics; D014947:Wounds and Injuries / Q000191:economics / Q000601:surgery