Medford-Davis LN, et al. - The authors aimed to ascertain factors correlated with being discharged from the second emergency department (ED) without procedures, or admission or observation among injured patients transferred from one ED to another. Over 33% of patients transferred to another ED for traumatic injury were discharged from the second ED without admission, observation, or procedures. Telemedicine consultation with sub-specialists could reduce such transfers.

• All patients with injury diagnosis codes transferred between two EDs in the 2011 Healthcare Utilization Project State Emergency Department and State Inpatient Databases for 6 states were examined.
• For this study, multivariable hierarchical logistic regression evaluated the association between the patient (demographics and clinical characteristics) and hospital factors, and discharge from the second ED without coded procedures.

• The authors found 48,160 ED-to-ED injury transfers in 2011, half of which (49%) were transferred to non-trauma centers, including 23% with major trauma.
• A total of 22,011 transfers went to a higher level of care.
• Out of them, 36% were discharged from the ED without procedures.
• Compared to torso injuries, discharge without procedures was more likely for patients with soft tissue (OR 6.8, 95%CI 5.6–8.2), head (OR 3.7, 95%CI 3.1–4.6), facial (OR 3.8, 95%CI 3.1–4.7), or hand (OR 3.1, 95%CI 2.6–3.8) injuries.
• Medicaid (OR 1.3, 95%CI 1.2-1.5) or uninsured (OR 1.3, 95%CI 1.2-1.5) status were included as other factors.
• For injury care, treatment at the receiving ED added an additional $2859 on average (95% CI $2750–$2968) per discharged patient to the total charges, not including the costs of ambulance transport between facilities.