Duplicate Trauma Care in Houston Hospitals

Houston, we have a problem in the hospitals. A new study from Baylor College of Medicine has found that one out of five orthopedic trauma patients treated in a Houston public hospital emergency department (ED) are repeating the same care they had in another Houston ED.

“When an orthopedic trauma patient comes to an ED for care, ” says the August 15, 2016 news release, “there are three traditional channels of care following initial treatment: the patient is admitted for inpatient treatment, the patient is discharged with orthopedic follow up, or the patient is transferred to another medical center for orthopedic care. In the Houston area, a fourth channel has emerged: indirect referral.”

This work, led by Laura Medford-Davis, M.D., assistant professor in emergency medicine at Baylor College of Medicine, found that patients arrive at the next facility via independent transport and without medical records, meaning that have to have all the prior tests repeated.

“In the study, we examine 1, 162 ED patients who came to the ED with orthopedic injury over a six-month timeframe, said Dr. Medford-Davis. During this period, 20% of the patients had already been seen for their injury at another Houston-area ED, and almost 90% of those patients were uninsured, compared to those who came to the safety net hospital through more traditional referral methods.”

Dr. Medford-Davis told OTW, “We researched this topic because, while working at the public hospital emergency department, we noticed many patients presenting to follow-up fractures that were initially diagnosed and splinted at other emergency departments. This seemed like an inefficient way to care for these patients, and we wondered how frequently this was actually happening, and what the real impact was on the patients and hospitals involved.”

“Orthopedic surgeons themselves are not usually the ones referring these patients to the public emergency department for follow-up care. Most referrals come from staff at the initial emergency department, staff at the orthopedic surgeons’ offices, or from the patients’ friends and family. However, in order to protect the interests of patients with orthopedic injuries, orthopedic surgeons could take a proactive role by reaching out to develop processes with their on-call hospitals, their office staff, and the public hospital.”

“All hospitals and orthopedic surgeons in a community should decide how they want to care for their uninsured orthopedic population and then collaborate to develop a streamlined referral system. For example, in communities where a safety-net hospital is the default provider for the uninsured population, sharing radiographic images between the initial emergency department and the safety-net system could significantly reduce the cost and delays caused by duplication of care.”

“Some patients have shared that they were asked to bring several hundred dollars to follow-up appointments with the on-call orthopedists they were referred to, and that this is why they chose to come to the public hospital instead. Others have said that a friend or family member recommended the public hospital as a lower-cost option because they anticipated that care would be expensive elsewhere. I am focusing current research on learning more about why patients come to the public emergency department for their follow-up care.”