Why this practice is really occurring remains an important question, Delgado acknowledges, and is the subject for numerous other studies now underway, he says. It may be that for many patients, proximity to their home is an important priority. "Or they may ask that they not be transferred to the 'county' hospital that treats mostly minority patients without insurance.' "
A Question of Distance
"If we find out that there is a strong patient preference for those with insurance to stay at their local hospital, the next step is to educate that population about the benefits of being treated in a trauma center when you have severe injuries," Delgado says.
Distance between the non-trauma hospital and the trauma center could be an issue, but probably isn't in this study, he says. "We know from our research at Penn that more than 86% of Americans have access via EMS transport to a level I or level II trauma center, either by helicopter or ground ambulance today." Another element of the story is that the researchers found this non-transfer trend at urban hospitals that are "very close to hospitals that are trauma centers."
There's also the possibility that emergency doctors at the non-trauma center are overly reassuring to the patient, minimizing the severity of their injuries, which in this study were largely due to falls and motor vehicle collisions.
"Our study raises more questions than it answers," acknowledges Delgado, who is working on a project to interview patients with severe trauma who stay in non-trauma hospitals for care. He hopes to learn more about why they stayed in the non-trauma facility.