Rural Trauma Team Development Course Decreases Time to Transfer for Trauma Patients.

Background: The Rural Trauma Team Development Course (RTTDC) is designed to teach knowledge and skills for the initial assessment and stabilization of trauma patients in resource-limited environments. The effect of RTTDC training on transfers from non-trauma centers to definitive care has not been studied. We hypothesized that RTTDC training would decrease referring hospital emergency department (ED) length of stay (LOS), time to call for transfer, pre-transfer CT imaging rate, and mortality rate. Methods: We conducted a pre/post analysis of trauma patients who were transferred from rural, non-trauma hospitals from 2012-2014. Patients from six rural hospitals that participated in an RTTDC course were compared to a control group of similar centers that did not participate in the course. Primary outcome evaluated was referring hospital ED LOS, which was estimated using a difference-in-differences regression model. Secondary outcomes were time to transfer call, pre-transfer CT imaging rates, and mortality. Results: 253 patients were available for study (130 RTTDC group, 123 control). Demographics, CT imaging and mortality rates were similar between the two groups. In the primary outcome, the RTTDC group experienced an overall 61-minute reduction in referring hospital LOS (p=0.02) compared to the control group. The RTTDC group also showed a 41-minute reduction (p=0.03) in time to call for transfer compared to controls. There were no differences in the secondary outcomes of pre-transfer CT scanning rates or mortality. Conclusions: RTTDC training shortens ED LOS at rural, non-trauma hospitals by more than one hour without increasing mortality. Future educational and research efforts should focus on decreasing unnecessary imaging prior to transfer as well as opportunities to improve mortality rates. This study suggests an important role for RTTDC training in the care of rural trauma patients and may allow trauma centers to recapture the "golden hour" for transferred trauma patients. Level of Evidence: Therapeutic/Care Management, Level III (C) 2016 Lippincott Williams & Wilkins, Inc.

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