Inefficiencies in care for uninsured orthopedic trauma patients are leading to indirect referrals and duplicate care in the emergency departments of safety-net hospitals in Houston, according to a new study published in Project Muse.
An indirect referral occurs when an uninsured patient receives care at one ED and is subsequently instructed to seek follow-up care at another ED, often at a local safety-net hospital. For the new study, researchers examined data on 1,162 adult patients who received orthopedic care in a public hospital ED during a six-month period in 2011.
Here are three things to know about the indirect referrals of orthopedic trauma patients to safety-net hospitals:
1. The results: The study's researchers were able to determine that one in five patients treated for an orthopedic injury in a public hospital had been directly referred to said hospital by another ED. Of these indirectly referred patients, 209 (88.6 percent) were uninsured.
2. The burden: Patients referred to secondary hospital EDs for follow-up treatment encounter several challenges. Because these patients do not arrive in an ambulance and are not processed via a transfer center, they arrive at the second care site with no medical records. Patients then have to undergo duplicate testing and refill out forms already completed at the first ED. This results in patients being burdened with medical bills they, in most cases, can't afford and hospitals having to devote resources and labor to conduct care that has previously been administered. The practice is both inefficient and costly.
"The amount of money being spent on performing duplicate care is astounding," said Laura Medford-Davis, MD, assistant professor in emergency medicine at Baylor College of Medicine in Houston and the study's lead author. "In this study alone, the hospital billed roughly $4.9 million for acute treatment of indirectly referred patients, including $526,880.45 for duplicate ED services."
3. Potential solution: Dr. Medford-Davis suggests the numbers gleaned from this study highlight the need for changes in the processes by which health information is exchanged. Secondary hospital EDs should be able to easily access information like X-ray charts from the first EDs in order to avoid duplicate care.
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