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Minimizing "Overtriage" to Trauma Centers Can Generate Millions in Savings, Study Says

Are you in the EMS or trauma center industry? What are your thoughts on overtriage? Are the study’s recommendations realistic and attainable? Read on.

Trauma care is the second highest contributor to US health care spending, because it is expensive treating the most severely injured patients who require significant resources and personnel. Trauma patients are most frequently transported to hospitals via emergency medical services (EMS) and most regions have trauma care systems. In a majority of EMS and trauma systems, personnel abide by national field triage guidelines to identify those who are seriously injured for transport to trauma centers. But a recent study suggests that a good portion of patients without serious injuries are being transported by EMS to trauma centers (overtriage). Researchers have now studied the cost impact of these overtriage patients to find the potential cost savings that would accrue from this eliminating overtriage in a study titled, “The Cost of Overtriage: More Than One-Third of Low-Risk Injured Patients Were Taken To Major Trauma Centers” published in Health Affairs, September 2013.

Researchers estimated costs by calculating the adjusted cost of acute care for injured patients transported by 94 EMS agencies to 122 hospitals in seven regions across the US, while measuring the patients overall and by injury severity.

Results showed that among the 288,832 patients that were of lower acuity, 41.5 percent were treated at major trauma centers. Moreover, researchers found that of the 248,342 low-risk patients (those who did not meet field triage guidelines for transport to trauma centers), 34.3 percent, were still transported to major trauma centers. This finding comprised up to 40 percent of acute-injury costs. Further results showed that among the 301,214 patient cases that were reviewed, the average adjusted per episode cost of care was $5,590 higher in Level I trauma centers than in a non-trauma hospital.

Study researchers concluded that by abiding by the field triage guidelines, which include the transport of low-risk patients to non-trauma centers, unnecessary health care costs can be reduced by saving major trauma centers up to $136.7 million annually. In addition, trauma systems can improve by transporting patients to the most appropriate facilities for care. Researchers also found that downstream costs are impacted when transporting low-risk patients to major trauma centers, which include costs of inpatient hospital services.

What is your opinion on this research and on the concept of over triage?

By Juliana Boyle, Vice President – The Abaris Group

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Joel, thank you for your comment. You brought up some very interesting and important points that continue to be key to this discussion. EMS personnel in the field have the very important decision of evaluating patients and determining where they are to be transported. We agree with you in that we need to gather and analyze the data and look for trends that can help create better policy for those in the field to abide by. The key is to find the balance between setting reasonable expectations for outcomes of patients while keeping costs at a minimum, will we ever find the perfect balance?

- The Abaris Group

This debacle has been going on for many years in the EMS world. I believe each geographical region throughout the United States faces their own particular quandries and complexities on how to manage a protocol suitable for trauma triage. Trauma as we know it is a very costly measure and is not so easily recoverable when it comes to cost, billing insurance , Govt. subsidies and of coarse the payee (ijured party). The game has changed with the way cost are recovered and the rules regarding govt. regulations , billing and recoverables , subsidies and so on etc... Trauma has always been considered a looser for most privately run Ambulance services , hospitals and Air transport. Most EMS systems today are jockeying around, restructuring and trying to figure out new creative ways to survive. All according to region and State , cost may vary and rules ,regulation play a large part in the whole scheme of things. From my experiences with working different EMS systems, all systems have their own set rules , regulations, protocols ,SOG's whatever you want to call them: which govern their transport priorities i.e Cardiac Alerts, Trauma Alert, Stroke Alert etc...Most protocols are standard, but vary from region to region. State to State. What I have experienced in the past when it comes to Trauma Alerts, us clinitians in the fields have a set criteria for which we base our decisions in determining a true viable trauma alert. The decision making is done fast and under lots of stress, we all understand the" Golden Hour " if you worked in the EMS field long enough. It's critical the decisions are made timely and effectively. The decision can be either life or death, precisely choosing the most appropriate facility to be tranported to can be very complicated when dealing with the unknown trauma injury. It always comes to reason that the professional field EMS worker errors on the side of caution and declares a "trauma alert" based on the rule of high index of suspicion due to the force,impact, inertia the body has sustained during a traumatic incident, and not based on a full "head to toe" complete neurological examination. We as field clinitians have an obligation and work in a very high stress environment. Timely decisions are critical ,some decisions on transport are based on protocol , some decisions are based on physical findings , every clinitians operates differently and handles stress at different levels, some better then others. It's easy to sit back and be that Monday night Quarterback and say this should have been done this way, but living in the world we do , it's always on the back of our mind that if we were to make a critical decision determining life or death , and if that decision is wrong, then how far strung out on the string are we going to be following barage of attacks from the lawyers and anybody else that wants to get into your pocket. It's always the Schlumberger & Schlumberger Syndrome that complicate matters. Can we change things and make the way we do business better, I believe absolutely yes !!! I would have to analyze and look at the overall picture a lot longer , study the trends from region to region. State to State and determine which is best for each individual EMS system . Gahering statistical information , compiling it and determing whats best might take some time , but I think there is always ways to make change for the better.. Cheers Joel

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