Abstract
BACKGROUND: Unnecessary transfers for hand surgery evaluation result in significant costs to patients and consume valuable resources at trauma centers. The financial ramifications of these transfers on the receiving institution is largely unknown. This study was constructed to determine the impact of nonindicated transfers at our level 1 trauma center. METHODS: We reviewed the records of 505 patients transferred from another facility to our emergency department between 2018 and 2023. Demographics and transfer specific information were collected. The American Society for Surgery of the Hand ER Hand Care Committee transfer guidelines were used to stratify patients into necessary and unnecessary transfers. The direct and indirect costs and total reimbursement for each unnecessary transfer were reviewed to determine the net operating margin over the 5-year period. RESULTS: Three hundred and nine patients (61%) did not need an urgent transfer to a higher level of care. Patients transferred unnecessarily were more likely to be uninsured (23% vs 15%). Most of these patients were discharged from the emergency department (73%). The payer mix for this analysis was 27% commercial, 25% Medicare, 22% Medicaid, 12% self pay, and 14% other. The net operating margin over 5 years was -$2628. Commercial insurance accounted for most of the financial gains. CONCLUSIONS: The financial impact of unnecessary transfers to our tertiary referral center for hand surgery consultation is not significant. The added benefits of lowering costs to patients and improving the use of emergency care resources by mitigating these transfers likely outweighs any financial impacts that may be experienced by receiving institutions.