scholarly journals COVID Oximetry @home: evaluation of patient outcomes

2021 ◽  
Author(s):  
Michael Boniface ◽  
Dan Burns ◽  
Christopher Duckworth ◽  
Franklin Duruiheoma ◽  
Htwe Armitage ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Patient Outcomes ◽  
Remote Monitoring ◽  
Odds Ratio ◽  
Service Evaluation ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Patient Deterioration ◽  
The North ◽  
Hospital Stays

Background: COVID-19 has placed unprecedented demands on hospitals. A clinical service, COVID Oximetry @home (CO@h) was launched in November 2020 to support remote monitoring of COVID-19 patients in the community. Remote monitoring through CO@h aims to identify early patient deterioration and provide timely escalation for cases of silent hypoxia, while reducing the burden on secondary care. Methods: We conducted a retrospective service evaluation of COVID-19 patients onboarded to CO@h from November 2020 to March 2021 in the North Hampshire (UK) community led service (a collaboration of 15 GP practices, covering a population of 230,000 people). We have compared outcomes for patients admitted to Basingstoke & North Hampshire Hospital who were CO@h patients (COVID-19 patients with monitoring of SpO2 (n=137)), with non CO@h patients (those directly admitted without being monitored by CO@h (n=633)). Odds Ratio analysis was performed to contrast the likelihood of patient outcomes resulting in 30 day mortality, ICU admission and length of stay greater than 3, 7, 14, and 28 days. Results: Hospital length of stay was reduced by an average of 6.3 days for CO@h patients (6.9 95% CI [5.6 - 8.1]) in comparison to Non-CO@h (13.2 95% CI [12.2 - 14.1]). The most significant odds ratio effect was on mortality (0.23 95%CI [0.11 - 0.49]), followed by length of stay > 14 days (OR 0.23 95%CI [0.13 - 0.42]), length of stay > 28 days (OR 0.23 95%CI [0.08 - 0.65]), length of stay > 7 days (OR 0.35 95%CI [0.24 - 0.52]), and length of stay > 3 days (OR 0.52 95%CI [0.35 - 0.78]). Mortality and length of stay outcomes were statistically significant. Only 5/137 (3.6%) where admitted to ICU compared with 52/633 (8.2%) for Non-CO@h. Conclusions: CO@h has demonstrated considerably improved patient outcomes reducing the odds of longer length hospital stays and mortality.

scholarly journals Outcomes of Neutropenic Patients with Clostridium difficile Infection

2020 ◽  
Vol 41 (S1) ◽  
pp. s339-s340
Author(s):  
Roopali Sharma ◽  
Deepali Dixit ◽  
Sherin Pathickal ◽  
Jenny Park ◽  
Bernice Lee ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Treatment Failure ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
End Point ◽  
Neutropenic Patients

Background: Data from Clostridium difficile infection (CDI) in neutropenic patients are still scarce. Objective: To assess outcomes of CDI in patients with and without neutropenia. Methods: The study included a retrospective cohort of adult patients at 3 academic hospitals between January 2013 and December 2017. The 2 study arms were neutropenic patients (neutrophil count <500/mm3) and nonneutropenic patients with confirmed CDI episodes. The primary outcome evaluated the composite end point of all-cause in-hospital mortality, intensive care unit (ICU) admissions, and treatment failure at 7 days. The secondary outcome evaluated hospital length of stay. Results: Of 962 unique cases of CDI, 158 were neutropenic (59% men) and 804 were nonneutropenic (46% men). The median age was 57 years (IQR, 44–64) in the neutropenic group and 68 years (IQR, 56–79) in the nonneutropenic group. The median Charlson comorbidity score was 5 (IQR, 3–7.8) and 4 (IQR, 3–5) in the neutropenic and nonneutropenic groups, respectively. Regarding severity, 88.6% versus 48.9% were nonsevere, 8.2% versus 47% were severe, and 3.2% versus 4.1% were fulminant in the neutropenic and nonneutropenic groups, respectively. Also, 63% of patients (60.9% in nonneutropenic, 65.2% in neutropenic) were exposed to proton-pump inhibitors. A combination CDI treatment was required in 53.2% of neutropenic patients and 50.1% of nonneutropenic patients. The primary composite end point occurred in 27% of neutropenic patients versus 22% of nonneutropenic patients (P = .257), with an adjusted odds ratio of 1.30 (95% CI, 0.84–2.00). The median hospital length of stay after controlling for covariates was 21.3 days versus 14.2 days in the neutropenic and nonneutropenic groups, respectively (P < .001). Complications (defined as hypotension requiring vasopressors, ileus, or bowel perforation) were seen in 6.0% of the nonneutropenic group and 4.4% of the neutropenic group (P = .574), with an adjusted odds ratio of 0.61 (95% CI, 0.28–1.45). Conclusions: Neutropenic patients were younger and their cases were less severe; however, they had lower incidences of all-cause in-hospital mortality, ICU admissions, and treatment failure. Hospital length of stay was significantly shorter in the neutropenic group than in the nonneutropenic group.Funding: NoneDisclosures: None

Outcomes of Recreational Activity-Associated Trauma in Elderly Persons on Blood-Thinning Medications

2017 ◽  
Vol 83 (4) ◽  
pp. 371-376 ◽  
Author(s):  
Zachary M. Deboard ◽  
Jonathan Grotts ◽  
Lisa Ferrigno
Keyword(s):  
Deep Vein Thrombosis ◽  
Length Of Stay ◽  
Elderly Patients ◽  
Odds Ratio ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Elderly Persons ◽  
Recreational Activities ◽  
Vein Thrombosis ◽  
Deep Vein

With increasing life expectancy, the elderly are participating in recreational activities traditionally pursued by younger persons. Elderly patients have many reasons for worse outcomes after trauma, one of which may be the rising use of anticoagulant and/or antiplatelet medications. This study aimed to determine whether preinjury use of these agents yielded worse outcomes in geriatric patients injured during high-impact recreational activities. The National Trauma Data Bank was reviewed from 2007 to 2010 for patients ≥65 years admitted to Level I or II trauma centers with ICD-9 E-codes for specific mechanisms of injury. These included motorcycles, bicycles, snowmobiles, all-terrain vehicles, equestrian, water and alpine skiing, snowboarding, and others. Patients with preinjury bleeding disorder (BD), including warfarin and clopidogrel use, were compared with controls via a coarsened exact matching analysis. BD patients (294) were compared with 3929 controls. Although increased in BD patients, no significant mortality differences were observed in unmatched or matched analyses. BD patients yielded greater hospital length of stay (5 vs 4 days, P = 0.020) with increased odds of receiving five units or more of blood (7.0% vs 2.1%, odds ratio = 4.7, P < 0.001) and of deep vein thrombosis (7.6% vs 3.8%, odds ratio = 2.1, P = 0.018). Elderly patients with BD, including warfarin or clopidogrel use, do not seem to have significantly increased mortality after injury during specified recreational activities. BD patients had greater hospital length of stay, transfusion requirements, and deep vein thrombosis rates. These findings may inform counseling for those taking such medications as to the potential for adverse outcomes.

scholarly journals Multimodal Analgesia in Lumbar Fusion Surgery: Impact Amidst the Opioid Epidemic

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Yi Lu ◽  
Erica Bertoncini
Keyword(s):  
Length Of Stay ◽  
Lumbar Fusion ◽  
Multimodal Analgesia ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
P Value ◽  
Standard Group ◽  
Fusion Surgery ◽  
Hospital Stays

Abstract INTRODUCTION Spine surgery traditionally relies on opioid analgesics for postoperative pain management. Opioids are associated with prolonged hospital stays and opioid use disorders. Opioid-focused prescribing habits in surgery have partially contributed to the opioid epidemic. METHODS A retrospective analysis was performed comparing patients receiving a multimodal analgesia regimen after lumbar fusion surgery vs control group receiving standard analgesia regimen. The multimodal regimen consisted of Acetaminophen 975 mg TID, Toradol 7.5 mg Q6 hours for 24-ho followed by Celebrex 100 mg BID for 7-d, Robaxin 500 mg Q6 hours prn for muscle spasms, Gabapentin 300 mg/100 mg TID for 4-wk, and prn narcotic. The standard regimen consisted of Acetaminophen 975 mg TID, narcotic prn, and muscle relaxant prn. There were 12 patients in the multimodal group and 26 patients in the control group evaluated over 3-mo and 6-mo time periods respectively. Primary outcomes included hospital length-of-stay, total and IV narcotic requirements in Morphine Milligram Equivalent (MME), and VASS pain scores. RESULTS Study results demonstrate differences between patient populations when focusing on the opioid-naïve participants. Opioid-naïve patients in the multimodal group were found to have significantly lower IV narcotic requirement than the control (0.22+/−0.67 mg/d for multimodal vs 5.36+/−5.56 mg/d for standard group, P-value = .001). These patients also had shorter hospital stays than the control (2.78+/−0.83 d for multimodal vs 3.53+/−1.17 d for standard group) but the difference was just below our threshold for significance (P-value = .066). Including both opioid-naïve and opioid-tolerant patients, no significant differences were found in hospital length-of-stay, MME, IV narcotic requirement nor VASS score between the multimodal group and the control groups (P-values of .46, .81, .36, and .91, respectively). CONCLUSION Overall, the study favors using multimodal analgesia in those undergoing lumbar spinal fusion surgeries as evident by considerably reduced IV narcotic requirement and nearly significant shortened hospital length-of-stay in opioid-naïve patients compared to control.

Service evaluation of an acute Parkinson's therapy pathway between hospital and home

2020 ◽  
Vol 27 (7) ◽  
pp. 1-6
Author(s):  
Christopher J Lovegrove ◽  
Jonathan Marsden
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Length Of Stay ◽  
Intervention Group ◽  
Service Evaluation ◽  
Hospital Length ◽  
Community Services ◽  
Hospital Length Of Stay ◽  
Hospital Environments ◽  
Home Based

Background People with Parkinson's disease report that inpatient hospital environments do not replicate their home setup. A therapy pathway was developed integrating early home-based assessment, therapy sessions with photographs of key home areas, enhanced communication with community services, and staggered discharge. Methods Outcome measures (length of stay and readmissions within 14 days) in people with Parkinson's disease on the therapy pathway (n=5) were compared to those previously receiving standard care (n=5). Results Mean length of stay was 7.2 days shorter in the intervention group and their discharge Lindop Parkinson's mobility scale score was 39.4% higher. No difference was found in the Modified Barthel Index between the groups. Both groups had the same readmission rates. The pathway was accepted by both people with Parkinson's disease and clinicians. Conclusions The pathway reduced hospital length of stay and increased mobility in patients with Parkinson's disease. It was accepted by patients and clinicians and was feasible to integrate into current practice. The pathway warrants further evaluation.

ERAS Protocols for Thyroid and Parathyroid Surgery: A Systematic Review and Meta-analysis

2021 ◽  
pp. 019459982110196
Author(s):  
Kevin Chorath ◽  
Neil Luu ◽  
Beatrice C. Go ◽  
Alvaro Moreira ◽  
Karthik Rajasekaran
Keyword(s):  
Length Of Stay ◽  
Odds Ratio ◽  
Perioperative Management ◽  
Meta Analysis ◽  
Hospital Costs ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Parathyroid Surgery ◽  
Inclusion Criteria

Objective Enhanced recovery after surgery (ERAS) protocols are evidenced-based multidisciplinary programs implemented in the perioperative setting to improve postoperative recovery and attenuate the surgical stress response. However, evidence on their effectiveness in thyroid and parathyroid surgery remains sparse. Therefore, our goal was to investigate the clinical benefits and cost-effectiveness of ERAS protocols for the perioperative management of thyroidectomy and parathyroidectomy. Data Source A systematic review of Medline, Scopus, Embase, and gray literature was performed to identify studies of ERAS or clinical care protocols for thyroidectomy and parathyroidectomy. Review Methods Two reviewers screened studies using predetermined inclusion criteria. Our primary outcomes included hospital length of stay and hospital costs. Readmission and postoperative complication rates composed our secondary outcomes. Meta-analysis was performed to compare outcomes for patients enrolled in the ERAS protocol versus standard of care. Results A total of 450 articles were identified; 7 (1.6%) met inclusion criteria with a total of 3082 patients. Perioperative components in ERAS protocols varied across the studies. Nevertheless, patients enrolled in ERAS protocols had reduced hospital length of stay (mean difference, –0.64 days [95% CI, −0.92 to −0.37]) and hospital costs (in US dollars; mean difference, –307.70 [95% CI, −346.49 to −268.90]), without an increase in readmission (odds ratio, 0.75 [95% CI, 0.29-1.94]) or complication rates (odds ratio, 1.14 [95% CI, 0.82-1.57]). Conclusion There is growing literature supporting the role of ERAS protocols for the perioperative management of thyroidectomy and parathyroidectomy. These protocols significantly reduce hospital length of stay and costs without increasing complications or readmission rates.

scholarly journals Major cardiothoracic trauma: Eleven-year review of outcomes in the North West of England

2015 ◽  
Vol 97 (4) ◽  
pp. 298-303 ◽  
Author(s):  
M Khorsandi ◽  
C Skouras ◽  
S Prasad ◽  
R Shah
Keyword(s):  
Length Of Stay ◽  
Tertiary Care ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Research Network ◽  
Treatment Unit ◽  
North West ◽  
Male Predominance ◽  
The North ◽  
Significant Difference

Introduction Up to 15% of patients with cardiothoracic trauma require emergency surgery, and death can be prevented in a substantial proportion of this group. UK reports have emphasised the need for improvement in this field. We assessed major cardiothoracic trauma (MCT) outcomes in North West England over 11 years. Methods The database from the Trauma Audit and Research Network was used to retrieve data for all patients who had suffered MCT between 2000 and 2011 in North West England and the findings analysed. Trauma that led to thoracotomy/thoracoscopy or sternotomy was defined as MCT. Results A total of 146 patients were identified, and a considerable male predominance (88.4%) noted. A total of 54.1% had sustained penetrating cardiothoracic trauma. Also, 53.4% had been admitted to tertiary-care hospitals for trauma (TCHT) and 46.6% had been admitted to non-TCHT. Overall prevalence of mortality was 35.6%. No significant difference was found in mortality between TCHT vs non-TCHT. Prevalence of mortality was significantly higher in the subgroup of patients cared for exclusively in non-TCHT compared with patients transferred from non-TCHT to TCHT (41% vs 13.8%, p<0.05). Conclusions No significant difference was demonstrated in length of stay in hospital/length of stay in the intensive treatment unit and prevalence of mortality between patients originally presenting in TCHT and those presenting in non-TCHT. However, patients transferred from non-TCHT to TCHT had a lower prevalence of mortality. These findings may constitute a valuable benchmark for comparison with results arising after introduction of trauma centres in the UK.

scholarly journals Poor Performance on a Preoperative Cognitive Screening Test Predicts Postoperative Complications in Older Orthopedic Surgical Patients

2017 ◽  
Vol 127 (5) ◽  
pp. 765-774 ◽  
Author(s):  
Deborah J. Culley ◽  
Devon Flaherty ◽  
Margaret C. Fahey ◽  
James L. Rudolph ◽  
Houman Javedan ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Postoperative Complications ◽  
Length Of Stay ◽  
Odds Ratio ◽  
Poor Performance ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Surgical Patients ◽  
Mortality Data ◽  
Cognitive Screening

Abstract Background The American College of Surgeons and the American Geriatrics Society have suggested that preoperative cognitive screening should be performed in older surgical patients. We hypothesized that unrecognized cognitive impairment in patients without a history of dementia is a risk factor for development of postoperative complications. Methods We enrolled 211 patients 65 yr of age or older without a diagnosis of dementia who were scheduled for an elective hip or knee replacement. Patients were cognitively screened preoperatively using the Mini-Cog and demographic, medical, functional, and emotional/social data were gathered using standard instruments or review of the medical record. Outcomes included discharge to place other than home (primary outcome), delirium, in-hospital medical complications, hospital length-of-stay, 30-day emergency room visits, and mortality. Data were analyzed using univariate and multivariate analyses. Results Fifty of 211 (24%) patients screened positive for probable cognitive impairment (Mini-Cog less than or equal to 2). On age-adjusted multivariate analysis, patients with a Mini-Cog score less than or equal to 2 were more likely to be discharged to a place other than home (67% vs. 34%; odds ratio = 3.88, 95% CI = 1.58 to 9.55), develop postoperative delirium (21% vs. 7%; odds ratio = 4.52, 95% CI = 1.30 to 15.68), and have a longer hospital length of stay (hazard ratio = 0.63, 95% CI = 0.42 to 0.95) compared to those with a Mini-Cog score greater than 2. Conclusions Many older elective orthopedic surgical patients have probable cognitive impairment preoperatively. Such impairment is associated with development of delirium postoperatively, a longer hospital stay, and lower likelihood of going home upon hospital discharge.

scholarly journals Hospital Outcomes of Adult Diabetic Patients by Glycated Hemoglobin Level in Nonsurgical Pathology in a High-Complexity Institution

2019 ◽  
Vol 12 ◽  
pp. 117955141988267
Author(s):  
German Camilo Giraldo-Gonzalez ◽  
Cristian Giraldo-Guzman ◽  
Abelardo Montenegro-Cantillo ◽  
Angie Carolina Andrade-García ◽  
Duvan Snaider Duran-Ardila ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Length Of Stay ◽  
Glycated Hemoglobin ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Diabetic Patients ◽  
Hospital Stays ◽  
The Relationship ◽  
Hba1c Levels

Recent evidence supports the relationship between in-hospital hyperglycemia and inpatient complications. Besides, glycated hemoglobin (HbA1c) can predict the clinical course of patients with type 2 diabetes mellitus (DM2) during hospital stays. This study aimed to assess the relationship between HbA1c levels and inpatient outcomes. Type 2 diabetes mellitus patients with age greater than 18 years, hospital length of stay greater than 24 hours, and one HbA1c report during their in-hospital management were included. All the electronic care records of patients admitted at the Clinical Versalles, a high-volume institution, in Manizales-Colombia were revised. The following variables were considered: hospital length of stay, diagnoses at the arrival, complications, capillary glucose levels, and treatment at discharge. Variables were categorized by HbA1c levels: group 1 = ⩽ 7%, group 2 = 7.01% to 8.5%, group 3 = 8.51% to ⩽10% and group 4 = >10%. There were a total of 232 patients. Average age was 69.7 years, mean HbA1c was 7.19 ± 2.03, average body mass index (BMI) was 28.8 ± 5.6. About HbA1c, 146 (62.9%) had ⩽7.5%. The most frequent admission diagnosis was by cardiovascular diseases. Average hospitalization was 7.5 ± 5.7 days. There was no relationship between the levels of HbA1c with hospital stays, inpatient complications, or readmissions. Infections and respiratory diseases were more common conditions related to higher HbA1c levels, especially when these were 8.5%. In diabetic patients with nonsurgical diseases and high HbA1c levels, there was no association with clinical complications, length of stay, readmissions, or in-hospital mortality, but changes in treatment at discharge were observed.

556 Hospital Length of Stay for Patients with Small and Medium Burns Impacted by Distance to Burn Center

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S118-S119
Author(s):  
Stephen Sibbett ◽  
Jamie Oh ◽  
Saman Arbabi ◽  
Gretchen J Carrougher ◽  
Nicole S Gibran
Keyword(s):  
Length Of Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Site Location ◽  
Chi Square ◽  
Hispanic Males ◽  
Burn Care ◽  
Burn Center ◽  
Significant Difference ◽  
Hospital Stays

Abstract Introduction Understanding contributors to patient length of stay is critical for burn center resource management and efficiency. In this study, we analyzed how distance from patient homes to a burn center impacts hospital length of stay. Methods Under IRB approval, we reviewed our trauma registry for burn patients admitted to a regional burn center from 2011 to 2018. Inclusion was limited to patients from the burn center state. Patients were grouped by distance from the home zip code to the burn center (≤100 and &gt;100 miles) according to what might be ground or air transport. Chi-square and Mann-Whitney tests were used to determine differences between groups by race, burn size (TBSA), hospital length of stay (LOS), LOS/TBSA, mortality, and disposition to home. Burn size was categorized by TBSA into small (0–20%), medium (21–50%) and large (51–100%) burns. Results Our study population was predominantly white, non-Hispanic males. Mean burn size was significantly higher in patients who traveled more than the &gt;100 miles to the burn center (Table). Mean LOS/TBSA was not significant between the two groups. However, controlling for burn size, patients with small and medium burns that lived farther from the burn center had significantly longer hospital stays. There was no significant difference in length of stay for patients with large burns, mortality or disposition to home between the two distance groups. Conclusions At a burn center with a large catchment area, patients with burn size &lt; 50%TBSA who lived more than 100 miles from the burn center had significantly longer hospital stays than those who lived closer to the burn center. This may indicate that patients who are referred to a regional burn center for care of smaller burns may require care beyond the level of their local hospitals. It is worth noting that using burn size as an indication of complexity of care may be misleading as body site location of the burn (e.g. hand, face or feet) impacts the recovery. Applicability of Research to Practice For a burn center that serves patients across a vast region, this investigation might be useful in identifying opportunities to provide care for patients who live far from tertiary burn care.

Overutilization of Helicopter Transport in the Minimally Burned—A Healthcare System Problem That Should Be Corrected

2019 ◽  
Vol 41 (1) ◽  
pp. 15-22 ◽  
Author(s):  
Jordan Roman ◽  
William Shank ◽  
Joseph Demirjian ◽  
Andrew Tang ◽  
Gary A Vercruysse
Keyword(s):  
Length Of Stay ◽  
Early Discharge ◽  
Hospital Length ◽  
Inhalation Injury ◽  
Hospital Length Of Stay ◽  
Admission Rates ◽  
Burn Center ◽  
Transport Distance ◽  
Hospital Transfer ◽  
Hospital Stays

Abstract Eighty-eight percent of all patients burned in North America suffer burns of less than 20% TBSA. These patients may need care at a burn center, but barring any inhalation injury or polytrauma, these patients do not require helicopter transport (HEMS). We sought to identify a cohort of patients suffering smaller burns who do not benefit from HEMS to establish significant health care system savings. A 5-year retrospective analysis of data collected from our trauma registry was performed. Patients were separated into two groups: HEMS and ground transport (EMS). A subanalysis was performed between those with smaller burns (&lt;20% TBSA and no ICU/OR requirement). ED disposition, hospital length of stay, distance transported, and cost was analyzed. Of 616 burn patients presenting to our center, 13% were transported by HEMS, 46% by ambulance, and 61% by private vehicle. Of those transported via HEMS, 38% had been evaluated and treated at an outside hospital before transfer. Patients transported via HEMS had larger burns (13 vs 9 %TBSA; P = .002) and deeper burns (P &lt; .001), longer hospital stays (P = .003), higher ICU admission rates (P &lt; .001), and mortality rates (P = .003) compared with those transported by EMS. Transport distance was a mean 5.5 times greater (88 vs 16 mi) in the HEMS group (P &lt; .001). Within this cohort, 53% of patients transported via HEMS suffered smaller burns, compared with 73% transported by EMS. A subanalysis of the smaller burns cohort showed increased distances of transport via HEMS (91 vs 18 mi; P &lt; .001) and increased rates of admission from the ED in the EMS group (93% vs 68% by HEMS; P = .005), yet no difference in length of stay, or rates of early discharge, defined as &lt;24-hour hospital stay. Fully 1/4 of those transported via HEMS with smaller burns were discharged from the ED after burn consultation, debridement, and dressing. Mortality in both was nil. Average cost per helicopter transport was US$29K. Accurate triage and burn center consultation before scene transport or hospital transfer could help identify patients not benefiting from HEMS yet safely transferrable by ground, or better served by early clinic follow-up, which would reduce cost without compromising care in this cohort. Annual patient savings approximating US$444K could be multiplied were non-HEMS transport universally adopted for smaller burns.

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