The Clock Is Ticking on Trauma Center Time to Transfer 

For the first time, the 2024 ESO Trauma Index took a deep dive into Time to Transfer data – a critical, patient-centered metric that directly impacts survival rates and care outcomes. Defined by the National Trauma Data Bank (NTDB) as the time between when a transfer order is written and when the patient physically leaves the facility, this metric sheds light on how well trauma systems move patients to the right place for the right care.

Delays from communication breakdowns, logistical issues, or procedural bottlenecks can make the difference between life and death. Specifically, traumatic brain injury, complex orthopedic injuries, and hemodynamic instability issues like hemorrhage all require rapid, specialized surgical intervention at higher-level trauma centers.

Key Findings: How Fast Are Trauma Patients Moving? 

In this first exploration of time to transfer data, ESO considered time to transfer for emergency department patients, time to transfer for inpatient patients, and if trauma center level mattered. Data from the ESO Data Collaborative, which includes nearly 1 million anonymized patient records, show: 

Emergency Department Transfers 

• The median time to transfer was 78 minutes (Range: 63–84 minutes) 
• Time to transfer varied by trauma center level but not significantly  

Inpatient Transfers 

• The median time to transfer was 141 minutes, nearly 2.5 hours (Range: 132–152 minutes)  
• There was no clear trend between trauma center levels and inpatient transfer time  

These findings challenge the assumption that higher trauma center levels always transfer patients more quickly. They also show that the proverbial ‘golden hour’ is rarely met, especially with inpatient transfers. There is room for improvement. 

A Successful Reduction in Time to Transfer

The Oregon Health and Science University conducted a three-year quality improvement project on patient transfers. Measurable improvements include:  

• Decreased the number of transfers that arrived with incomplete (or missing) medical records from more than 17% to just over 1%  
• Decreased arrival-to-procedure time for patients being transferred for a procedure from 51 hours to 35 hours  
• Decreased unnecessary transfers from 15% to 3%  
• Increased case mix index by one-third, corresponding to about a 60% jump in reimbursement 
  

How Can Trauma Centers Reduce Transfer Delays? 

Trauma leaders, including the American College of Surgeons (ACS), emphasize the importance of rapid – and accurate – injury identification, established transfer protocols, and seamless communication between referring and receiving facilities. 

Best practices for improving time to transfer include: 

• Quickly identify trauma patients requiring transfer – ideally within 30 minutes of arrival 
• Establish clear criteria for transfer, prioritizing patients needing specialized surgical care 
• Create predefined agreements with higher-level trauma centers to streamline transfers 
• Facilitate direct physician-to-physician communication for quicker acceptance 
• Appoint a dedicated transfer coordinator to reduce logistical delays
• Focus on stabilization without unnecessary imaging or procedures that slow down the process 
• Set and track a decision to transfer time as part of your trauma performance improvement program
• Regularly review transfer times with staff and provide feedback on identified delays 
• Ensure compliance with state and regional trauma guidelines, some of which mandate specific transfer timeframes  

The Bottom Line: Faster is Better 

The data is clear: time to transfer can be improved, and hospital systems and trauma centers that optimize transfer times can improve patient survival and recovery. 

Want to see how your facility compares to national benchmarks?

Download the full 2024 ESO Trauma Index to learn how your trauma center could improve patient outcomes and community health.