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Easing the strain on a pediatric tertiary care center: use of a redistribution system
Stephen B Freedman1, Vidhi A Thakkar
1Division of Paediatric Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada. stephen.freedman@sickkids.ca
Insights
This study found that regionalized patient transfer systems are safe for children needing hospital admission. However, most caregivers preferred not to be transferred again, and the system did not significantly change emergency department use.
Area of Science:
- Pediatric healthcare systems
- Patient transfer protocols
- Healthcare logistics
Background:
- Regionalized healthcare systems aim to optimize patient flow and resource allocation.
- Effective transfer protocols are crucial for maintaining patient safety and satisfaction.
- Evaluating the safety and impact of transferring pediatric patients from tertiary to community hospitals is essential for system improvement.
Purpose of the Study:
- To assess the safety and efficacy of a regionalized system for transferring pediatric patients requiring admission from a tertiary care center to regional or community hospitals.
- To evaluate caregiver satisfaction with the transfer process and care received at the receiving facility.
- To determine the long-term impact of such transfers on subsequent emergency department utilization at the tertiary care center.
Main Methods:
- A cohort study involving children requiring admission from a tertiary care center's emergency department (ED).
- Caregivers of transferred children (n=344) and a comparison group (n=253) were surveyed regarding satisfaction and transfer experience.
- Subsequent ED use at the tertiary care center was tracked for two years post-transfer.
Main Results:
- The transfer process was associated with minor issues like intravenous access problems and delayed antibiotic administration in a small number of children.
- Caregiver satisfaction with the transfer process was high (92.3%), but only 47% would agree to a similar transfer in the future.
- Transferred children showed a trend towards reduced revisits to the tertiary care center ED (39.9% vs. 49.6%), though the mean number of visits remained unchanged.
Conclusions:
- The regionalized patient redistribution program was deemed safe for pediatric transfers.
- Despite safety, caregiver preference leaned against repeat transfers, highlighting the need for improved communication and support.
- The implemented redistribution system did not substantially alter long-term emergency department utilization patterns at the tertiary care center.
Objective:
To evaluate the ability of a regionalized system to safely transfer patients requiring admission from a referral center to either regional or community hospitals.
Design:
Cohort study of children requiring admission. Following transfer, a questionnaire was administered to eligible caregivers. Subsequent emergency department (ED) use was assessed by comparing children who were transferred with those who were not.
Setting:
The Hospital for Sick Children, Toronto, Ontario, Canada, from April 1, 2003, through March 31, 2004.
Participants:
Caregivers of 371 children who underwent transfer from a tertiary care center ED to either a regional or a community hospital were eligible; 344 were contacted. Two hundred fifty-three children for whom transfer was considered but was not performed served as a comparison group. Intervention Questionnaire administered to caregivers, combined with database review.
Main Outcome Measures:
Failure of the transfer process, caregiver satisfaction, and future tertiary care center ED use.
Results:
Five children experienced intravenous access problems, and 4 children experienced delayed antibiotic administration. Caregiver satisfaction was 92.3% with the transfer process and 84.4% with the care at the receiving hospital. Forty-seven percent of caregivers indicated that they would agree to a similar transfer in the future. Two years later, fewer transferred children (39.9%) than those who were not transferred (49.6%) had revisited the tertiary care center ED (odds ratio, 1.52; 95% confidence interval, 1.10-2.10). The mean number of visits was unchanged (95% confidence interval of the difference, -0.44 to 0.21 visits).
Conclusions:
Although we found the redistribution program to be safe, caregivers stated a preference not to be transferred again. The redistribution system did not substantially alter tertiary care center ED use.
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