Trauma requires a certain level of care to ensure the best outcome. A study revealed that severely injured patients with insurance are at risk for lower quality care because hospitals are more likely to admit them then transfer them to a trauma center where they can get specialized care.
The study from Stanford University was published in JAMA Surgery on Wednesday. Despite a problem known a “patient dumping” has occurred in some instances, in which hospitals transfer out patients who do not have insurance, researchers found that insured patients sometimes get poor treatment, as well. Specifically when they are brought in to the emergency room with severe, life-threatening injuries. They are admitted to the local hospital anyway, rather than being transferred to a trauma center where they could receive the care the need to survive.
Led by Dr. Kit Delgado, emergency care researcher at the University of Pennsylvania, the team looked at 4,500 trauma cases from 636 hospitals. The data used was from the Department of Health and Human Services. They set out to study admitting practices as they related to those with insurance and those without. They found that hospitals were more likely to admit uninsured patients rather than sending them to a trauma center, which is better equipped to handle the situation. In fact, local hospitals are 13 to 15 percent more likely to admit severely injured patients who have insurance. Community hospitals, they found, were more likely to send patients to trauma centers, as needed, since they are not qualified to deal provide that level of treatment.
Survival rates for severely injured patients is increased by 25 percent when cared for in a trauma canter, by staff that regularly deals with difficult situations and life-threatening injuries. Being treated at a local hospital creates a less positive outcome in some cases and is risky for patients.
The results of the study suggest that admitting trauma patients with insurance is done strictly for financial reasons. It is not the doctors and nurses who make this vital decision, but the hospital administrators. It makes sense that they would admit those with insurance and not transfer them out too soon, but that does not account for the critical time after a traumatic incident when treatment is most important. The business side of hospitalization is not always best for patient care.
Dr. Nancy Wang, another author of the study said that it confirmed findings of a previous study done at the University of Toronto. Disparities exist regarding among care in children, elderly, men and women. She finds the disparities “disturbing.” Wang states that there needs to be a higher level of monitoring in emergency rooms to ensure that all patients receive fair treatment, regardless of age, gender or insurance status.
The team is planning three follow-up studies to get a better analysis of the data. They did not account for elderly patients, those who died or patients who chose not to go to a trauma center. However, if they reach the same conclusions, it is a wake up call for hospitals. It is also something for patients to be aware of, as having insurance may be risky for those with severe injuries.
By Tracy Rose