Effect of Policy Change on the Use of Long-Distance Transport and Follow-Up Care for Patients With Traumatic Finger Amputations

Abstract

In January 2006, the American College of Emergency Physicians released updated guidelines for air transfer. Digit amputation and near-amputation were no longer an indication for this costly service. We analyzed the effect of this update on the use of air transport and associated care outcomes for finger amputation patients and examined factors involved in providing follow-up care for these patients. A retrospective chart review identified all patients treated for traumatic finger amputation between 1995 and 2012 at a major hand trauma referral center. Analysis of available outcome measures was conducted using multiple logistic and linear regression models. Analysis of factors affecting frequency of return visits was performed via negative binomial regression. We identified 724 patients with isolated traumatic finger amputations. A total of 267 patients (37%) were transferred from an outside hospital. Patients injured after 2006 were less likely to be transferred via air, with a decrease from 29.5% pre-2006 to 14.9% post-2006. There was no difference in likelihood of replantation success, length of hospital stay, or number of return visits pre- versus post-2006. Patients transferred via helicopter after 2006 were more likely to be younger than 20 years of age and injured in a winter month. Following successful replantation, work-relatedness was associated with a higher number of return visits, whereas increasing age and transfer from farther than 100 miles away were associated with fewer. After the American College of Emergency Physicians policy update, decreased use of emergency air transport to a hand trauma referral center for patients with traumatic finger amputations did not adversely affect care delivery and outcomes. These changes may be successfully implemented on a center-by-center basis to reduce costs without detriment to patient care; however, coordination of follow-up care for long-distance transport patients may require special focus when designing policy around referral centers. Therapeutic IV.