Patient requests and proximity lead first responders to send low-risk patients to trauma hospitals, driving up the cost of care.

Sending patients with low-risk injuries to major trauma centers makes for larger medical bills and costs hospitals $130 million a year, according to a new study released this week by Oregon Health & Science University.

The study, which spanned January 2006 to December 2008, found that emergency responders in seven metro areas in the Western United States unnecessarily sent 85,000 patients to costly trauma hospitals. The average cost of care at the most advanced facilities was $5,590 higher than at a non-trauma hospital.

The two biggest reasons patients were wrongly transported to trauma hospitals: proximity and preference, said Craig Newgard, lead author of the study.

“A lot of the focus has been looking at patients with a lot of chronic medical problems and how to better manage their care,” Newgard said. “911 has been left out of the conversation. It needs to be considered in the health care reform process. There are large cost implications downstream.”

The study looked at emergency medical responder information from the Portland/Vancouver, Sacramento, Santa Clara, and Salt Lake City metro areas, as well as San Francisco, King County in Washington, and Denver County in Colorado. The locations were selected based on existing relationships and easily accessible data, Newgard said.

Emergency responders base their decision as to whether a patient is high-risk and needs trauma care on roughly two dozen nationally established guidelines, which include low blood pressure, confusion, penetrating injuries to the torso, and high-risk car crashes.

For hospitals, responders’ decisions may mean higher patient costs, which drive up expenses in the medical system as a whole. For patients, it means bigger bills. Trauma centers carry a heftier price tag because they have advanced equipment and specialists on duty around the clock.

“To many people, it’s no surprise that getting care in a trauma center is going to be more costly,” Newgard said. “We wanted to at least understand how much more expensive and the implications.”

However, reforming the system could have unintended consequences and will require a variety of stakeholders to weight in. For one, requiring low-risk patients to go to the nearest non-trauma hospital could result in longer transport times and more inter-hospital transfers, Newgard said.

Also, the study showed that two percent of patients initially diagnosed as low-risk turned out to be high-risk and needed care in a trauma facility.

“How reform happens is going to be a conversation that multiple stakeholders are going to have to have,” Newgard said. “It’s part of the solution [for reducing costs], but it’s a matter of how it is done.”