Healthcare News & Insights

‘Low-risk’ patients treated at trauma centers cost healthcare industry millions

When industry experts look at where they can cut healthcare costs, many focus on patients with chronic conditions and how to keep them from being readmitted to hospitals. But efforts also should be focused on another area where substantial costs savings can be made — out-of-hospital and trauma services. 115816052Reason: Emergency responders often transport people who aren’t seriously injured to high-level trauma centers, where care is provided at a much higher cost.

A recent study at the Oregon Health & Science University (OHSU) found that the emergency medical systems (EMS) transported more than 85,000 patients to major trauma hospitals, when the patients didn’t need that high-level  care. The study, which was conducted over a three-year period in seven metropolitan areas in the western United States, calculated it costs our healthcare system more than $130 million a year.

“What our study shows is there are huge cost implications in how EMS systems work to get injured patients to the appropriate hospitals,” Dr. Craig Newgard, director of the OHSU Center for Policy and Research in Emergency Medicine and the study’s lead author, said in an OHSU release. “And it shows how very early decisions in the process of health care — even prior to a patient arriving at the hospital — can lead to much higher costs downstream for our health care system.”

Wasting dollars

Trauma care consumes 10% of our nation’s medical expenditures, and is second only to heart disease, as the biggest driver of healthcare costs in the U.S. And treating injuries at Level 1 trauma hospitals costs twice as much as it does at a non-trauma hospital.

The care costs more because Level 1 and Level 2 trauma centers are staffed 24/7 with trauma surgeons and other experts who provide care to the most medically complex patients, and are equipped with the specialized technology and resources required to care for these patients.

While care in trauma centers is expensive, it’s justifiable for patients who need that level of care. It isn’t, however, for patients who are considered “low-risk.”

And in about one-third of the cases studied, patients who didn’t need trauma centers were sent there anyway.

Triage criteria

The study, which was recently published in the journal Health Affairs, looked at emergency services calls from 94 EMS agencies. Since the agencies used national trauma triage guidelines to decide where to transport patients, the researchers believe the findings are representative of what happens throughout the country.

These EMS guidelines are composed of more than 24 “triage criteria.” And if a patient meets just one of them, like low blood pressure, confusion, penetrating injury to the torso or high-risk auto crash, he or she should be taken to a trauma center.

Problem is, even for patients who don’t meet one of the criteria, they may still be taken to a trauma center because they request it or it’s the nearest hospital.

“First and foremost, what the patient wants to do drives what we do,” Randy Lauer, general manager of American Medical Response, an ambulance provider, told OregonLive.com.

Plus, Lauer went on to explain that the emergency medical care systems tend to be conservative, and have little tolerance for error.

Complicated issues

Like most things in the healthcare industry, this issue is way more complicated that it initially seems. That’s why additional studies are needed.

Currently, Dr. Newgard is leading a follow-up study on why patients who don’t meet the criteria are taken to major trauma centers.

In addition, Lauer said two emergency response pilot programs are tackling how to curb unnecessary emergency costs in the coming year.

 

 

 

 

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