1%-13.9% discrepancy [PH]; 20.8%-31.1% discrepancy [IH]). Figure 3 Potential funding discrepancy per patient (difference

between actual cost and peer group average cost) for pre-hospital (PH) and inter-hospital (IH) HEMS transfers, weighted by increasing over-triage thresholds (ISS≤12). Discussion Helicopter transport is an integral component of modern trauma systems which, in turn, have been shown to reduce preventable mortality in Australia [1,19]. However, few studies have investigated the financial implications of such systems, particularly from the perspective of the Inhibitors,research,lifescience,medical hospitals that receive trauma patients. Our study aimed to investigate the financial implications of HEMS over-triage from the perspective of the major trauma centre in NSW. In doing so,

we have provided the first state-wide description of HEMS patient characteristics and estimates of HEMS over-triage. In addition to previous literature demonstrating the inadequacy of the episode Inhibitors,research,lifescience,medical funding model [20-23], our results highlight the implications of episode funding to a major trauma hospital that receives HEMS patients. Specifically, in terms of potential funding discrepancies, Inhibitors,research,lifescience,medical over-triaged HEMS patients may be as costly to a trauma centre as correctly triaged patients. Further, the financial impact of receiving HEMS patients varies by the type of transport undertaken (either pre-hospital or inter-hospital). In many developed countries, HEMS are used to complement existing ground infrastructure. Recent reviews have Inhibitors,research,lifescience,medical shown a consistent association between

HEMS use and improved patient outcomes in trauma [24,25]. However, due to the difficulty in accurately determining patient acuity, HEMS patients are frequently over-triaged; resulting in patients being transported who do not require advanced care or expedient transport. Our results demonstrate that HEMS patients in NSW have a high over-triage rate. This is consistent with a meta-analysis of the HEMS literature showed 60% of patients (99% CI: 54.5%-64.9%) transported by HEMS had minor injuries Inhibitors,research,lifescience,medical below and 25.8% (99% CI: -1.0%-52.6%) were http://www.selleckchem.com/CFTR.html discharged within 24 hours [11]. Patients transported by HEMS in NSW may be over-triaged, however, our data did not allow assessment of transport protocol adherence. In NSW, HEMS are currently activated either by emergency call information (via a rapid launch coordinator) or via on on-scene paramedic according to service protocols, which rely on criteria such as patient physiology and mechanism of injury. In terms of discriminative accuracy, previous research has shown currently used criteria (including injury mechanism, physiology and anatomy of injury) to rely on a limited evidence base [26]. Our results confirm the advanced diagnostic capability and oversight which is possible in inter-hospital transfers lead to patients with a higher acuity being transferred by HEMS.