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The impact of referring hospital resources on interfacility overtriage: a population-based analysis


Background — Nearly half of patients transferred from non-trauma to trauma centres have minor injuries. The transfer of patients with minor injuries to trauma centres is not associated with any known patient benefit and represents an opportunity to reduce healthcare costs and improve patient experience. In this study, we evaluated the relationship between hospital resources and overtriage, with the objective of identifying targets for system-level intervention.

Methods — We conducted a population-based cohort study of adults, age ≥ 16, presenting with minor injuries to non-trauma centres in Ontario, Canada (2009–2020). The primary outcome was overtriage, defined as transfer to a trauma centre. Hierarchical logistic regression was used to evaluate the association between hospital resources and a patient’s likelihood of being overtriaged, adjusting for case-mix.

Results — Amongst 165,302 patients with minor injuries, 15,641 (9.5 %) were transferred to a trauma centre (overtriage). Presence of a CT scanner, surgical support, or intensive care unit had no impact on a patient’s likelihood of overtriage. Relative to community hospitals, presentation to a teaching hospital was independently associated with greater odds of overtriage (OR 2.97, 95 % CI: 1.26–7.00). Accounting for case-mix and resources, the median difference in a patient’s odds of overtriage varied 3.7-fold across non-trauma centres (MOR 3.76).

Conclusions — There is significant variability in overtriage across non-trauma centres, even after adjusting for case-mix and hospital resources. These finding suggests that some centres have developed processes to minimize overtriage independent of available resources. Broad implementation of these processes may represent an opportunity for system-wide quality improvement.



Tillmann BW, Nathens AB, Guttman MP, Pequeno P, Scales DC, Pechlivanoglou P, Haas B. Injury. 2024; 55(3):111332. Epub 2024 Jan 16.

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