Trapped in transit: Delays in hospital transfers put Illinois lives at risk

• Link to: Northwestern Now Story

• Illinois hospitals struggle to transfer patients fast to trauma centers, causing preventable deaths
• 17-34% of critically injured patients are first taken to non-trauma ERs, where they face delays
• Scientists offer solutions, including the COVID-era bed trackers to improve transfer speeds
• ‘There is so much potential to save people from dying at small, non-trauma hospitals’

CHICAGO -- An emergency can strike anyone, anywhere, but only some hospitals are equipped to handle critically injured patients. Of these patients, up to a third are first taken to the closest non-trauma-specialized hospitals before being transferred to a higher-level trauma center. In a life-or-death emergency, every second counts — and these transfers, often averaging more than double the recommended two-hour window, can lead to preventable deaths. 

In the first study to address why severely injured patients in Illinois are not transported to trauma-specialized hospitals as quickly as possible, Northwestern Medicine scientists identified a crucial need to improve inter-hospital transportation of patients as well as communication of their clinical information.

“In the hospital system, we’re more than just the sum of our parts,” said senior study author Dr. Anne Stey, assistant professor of surgery at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician. “How we work together in these spaces is really, really critical for actually saving people's lives.” 

Improving inter-hospital coordination, the scientists said, will require increased access to critical-care ambulances and training of transport staff in addition to new mechanisms to exchange information, including radiology scans and estimated arrival times, between hospitals. 

The study, which was published in the journal Annals of Surgery in recent months, surveyed nine high-level trauma hospitals and three high-level pediatric trauma centers across Illinois. The team spoke with 64 health care workers involved throughout the receiving end of the transfer process to determine the most urgent areas for improvement.  

An earlier study from Stey and her team examined the sending end of the transfer process. It found the most urgent problems identified by non-trauma or lower-level trauma hospitals were a lack of clear and consistent criteria for which patients should be transferred and the inability to connect with higher-level trauma centers that would accept their patients.  

“That there wasn't a little more synergy was surprising to me,” Stey said. 

To begin to address these gaps as soon as possible, Stey’s team is developing guidelines for hospital staff. One solution that has already been introduced into the field is a bed tracker. During the height of COVID-19 hospitalizations, the Chicago Department of Public Health (CDPH) required hospitals to update the number of available beds twice per day.  

CDPH created a tracker for hospitals to share their bed capacity data directly from the electronic health record, which could then be viewed on a shared dashboard. According to scientists, this tool would save valuable time and reduce human error compared to assigning the task to an already busy nurse or other health care worker.  

“This is a way of saving lives that is within our reach for daily emergencies like traumatic injuries and heart attacks as well as for the next pandemic or natural disaster,” Stey said.

“If hospitals are willing to collaborate more broadly around sharing the bed resources that they have available and prioritizing injured patients in particular, there is so much potential to save people from dying at small, non-trauma hospitals.” 

The National Institutes of Health funded this study. The National Heart Lung and Blood Institute also funded this work (grant number K23HL157832).