A/Prof. Clinton Gibbs1,2,3, Dr Alaina Gillan4, Prof Kerrianne Watt3,5, Dr Vinay Gangathimmaiah2,3
1Retrieval Services Queensland, 2Townsville University Hospital, 3James Cook University, 4Cairns Hospital, 5Queensland Ambulance Service
Biography:
A/Prof Clinton Gibbs is a senior staff specialist at Townsville University Hospital Emergency Department, and the Clinical Director for Research at Retrieval Services Queensland. He is an experienced prehospital and retrieval clinician, and medical coordinator. A/Prof Gibbs is enthusiastic about research in PHRM, with a focus on the inequity of care received by rural and remote persons. He is currently completing his PhD at James Cook University.
Abstract:
Most rural and remote health facilities in Queensland are without an on-site CT scan, and many people who sustain a mild traumatic brain injury (mTBI) are transferred from these facilities to ones with a CT. In Queensland, interhospital transfers are facilitated by the Queensland Ambulance Service or Retrieval Services Queensland. The REMAIN Study aimed to evaluate the current practice for patients with an mTBI who are being transferred from rural and remote non-CT capable facilities in Queensland, and to evaluate the use of Clinical Decision Rules (CDRs) in such transfers.
A retrospective study of all adult patients with mTBI who initially presented to a nonCT-capable facility in Queensland and were subsequently transferred by road ambulance or aeromedical services to a CT-capable facility over a 5-year period was performed, using linked data from QAS, RSQ and Queensland Health patient data collections.
Our results showed that the vast majority (>90%) of people experienced a “low-value” transfer. That is, they either did not receive a CT scan (11%) or had a scan result that did not require neurosurgical consultation (81%). None had documented use of a CDR to guide their transfer. The median time from initiation of transfer to final discharge from hospital was over 25hr.
The majority of transfers of people with a mTBI are arguably of “low-value”, with significant impact on individual patients and the healthcare system. Efforts should be made to reduce these transfers, including adherence to CDRs and exploring the role of point-of-care biomarkers.