Accelerating Rural Trauma Transfers: Evaluation of an Auto-Accept Protocol

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Background Trauma patients require rapid identification and evaluation to prevent care delays that impact outcomes, especially in rural hospitals with limited resources. To expedite transfers for higher-level care, our level I trauma center implemented an auto-accept (AA) protocol, a system-wide guideline for expedited patient transfer. This study evaluates the impact of our AA protocol on interfacility transfer times and clinical outcomes. Methods This retrospective cohort study identified trauma patients transferred from referring hospitals (RHs) through the trauma registry between January 2017 and October 2024. Patients were divided into those transferred prior to protocol implementation (Pre-AA) and after (Post-AA). Transfer times and trauma center disposition were used to assess efficiency. Demographics, RH imaging, injury patterns, and hospital events and outcomes were collected. Data was analyzed using bivariate analysis. Results The cohort included 272 patients (136 Pre-AA and 136 Post-AA), 79% male, average age 43.9 ± 17.0 years, and ISS 13.5 ± 11.2. Post-AA patients had significantly shorter transfer times (1.81 hr [1.37-2.36] vs 2.88 hr [1.93-4.53], P < .001), lower odds of receiving imaging at RHs (OR = 0.423 [0.213-0.843]), and reduced odds of trauma admission (OR=0.198 [0.078-0.502]). Age, ISS, discharge disposition, and mortality did not differ significantly between groups ( P = .111, 0.126, 0.622, 0.377, respectively). Discussion Implementation of an AA protocol was associated with earlier interfacility transfer and reduced pre-transfer imaging. Discharge disposition, mortality rates, and length of stay were not significantly changed. The AA protocol demonstrated its potential to accelerate patient triaging to definitive care without negatively affecting morbidity or mortality. Reduced transfer time benefits RHs by accelerating patient care and easing resource strain.

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