{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T18:20:39Z","timestamp":1787768439158,"version":"build-2784847793"},"reference-count":12,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T00:00:00Z","timestamp":1787443200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"abstract":"\n Background<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The cohort included 272 patients (136 Pre-AA and 136 Post-AA), 79% male, average age 43.9 \u00b1 17.0\u00a0years, and ISS 13.5 \u00b1 11.2. Post-AA patients had significantly shorter transfer times (1.81\u00a0hr [1.37-2.36] vs 2.88\u00a0hr [1.93-4.53],\n P<\/jats:italic>\n < .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 (\n P<\/jats:italic>\n = .111, 0.126, 0.622, 0.377, respectively).\n <\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/00031348261480816","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T06:36:37Z","timestamp":1787553397000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Accelerating Rural Trauma Transfers: Evaluation of an Auto-Accept Protocol"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2015-1100","authenticated-orcid":false,"given":"Aliya G.","family":"Burns","sequence":"first","affiliation":[{"name":"Department of Surgery, East Tennessee State University Quillen College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Maddex","family":"Webb","sequence":"additional","affiliation":[{"name":"Brookwood Baptist Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalli L.","family":"Devecki","sequence":"additional","affiliation":[{"name":"Department of Surgery, East Tennessee State University Quillen College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah A.","family":"King","sequence":"additional","affiliation":[{"name":"Department of Trauma Services, Ballad Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah W.","family":"Collins","sequence":"additional","affiliation":[{"name":"Department of Trauma Services, Ballad Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna G.","family":"Hodge","sequence":"additional","affiliation":[{"name":"Baylor University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"J. Bracken","family":"Burns","sequence":"additional","affiliation":[{"name":"Department of Surgery, East Tennessee State University Quillen College of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,23]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.293.21.2626"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000002248"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1080\/10903127.2019.1632997"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e31803c5665"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3181e4d579"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10140-021-01938-x"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2024.112017"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.12299"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2023.10.024"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2021.08.022"},{"key":"e_1_3_3_12_2","volume-title":"Advanced Trauma Life Support: Student Course Manual, 10th Ed","author":"American College of Surgeons Committee on Trauma","year":"2018","unstructured":"American College of Surgeons Committee on Trauma. Advanced Trauma Life Support: Student Course Manual, 10th Ed American College of Surgeons; 2018."},{"key":"e_1_3_3_13_2","volume-title":"Resources for Optimal Care of the Injured Patient: 2022 Standards, 7th Ed","author":"American College of Surgeons Committee on Trauma","year":"2022","unstructured":"American College of Surgeons Committee on Trauma. Resources for Optimal Care of the Injured Patient: 2022 Standards, 7th Ed American College of Surgeons. 2022. PDF. Accessed February 16, 2026.https:\/\/www.facs.org\/quality-programs\/trauma\/quality\/verification-review-and-consultation-program\/standards\/"}],"container-title":["The American Surgeon\u2122"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348261480816","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00031348261480816","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348261480816","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T17:51:47Z","timestamp":1787766707000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00031348261480816"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,23]]},"references-count":12,"alternative-id":["10.1177\/00031348261480816"],"URL":"https:\/\/doi.org\/10.1177\/00031348261480816","relation":{},"ISSN":["0003-1348","1555-9823"],"issn-type":[{"value":"0003-1348","type":"print"},{"value":"1555-9823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,23]]},"article-number":"00031348261480816"}}