Analysis of compliance and outcomes in a trauma system with a 2-hour transfer rule.

Hypothesis: Minimizing time to definitive care in an effort to optimize outcomes is the goal of trauma systems. Toward this end, some systems have imposed standards on time to interfacility transfer. This study evaluates compliance and outcome in a system with a 2-hour transfer rule. Design: Retrospective review. Setting: State trauma registry data from 1999 to 2003. Patients: Trauma patients who underwent interfacility transfer and those who did not. Main Outcome Measures: Time to transfer; Injury Severity Score; mortality; and time to operating room at second facility. These variables were then stratified by time to transfer. Results: During the study period, there were 22 447 interfacility transfers. Overall transfer rate was 10.4%. Of the transfers, 4502 (20%) occurred within 2 hours. Me-dian transfer time was 2 hours 21 minutes. Injury Severity Score, mortality, and number of patients with operation performed on same day of transfer were all higher for the group transferred within 2 hours in comparison with patients transferred on the same day of injury at greater than 2 hours. Conclusions: While the majority of transfers occur at greater than the mandated 2-hour interval, the most seriously injured patients are reaching definitive care within 2 hours. Markers of acuity for patients transferred at greater than 2 hours parallel those of the general trauma patient population. These data suggest that, in this system, providerdetermined transfer time that exceeds 2 hours has no adverse effect on patient outcome. It appears to accomplish recognition and rapid transport of the most seriously ill. This may obviate the need for onerous system mandates that are not feasible or have poor compliance.