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Effect of interhospital transfer on resource utilization and outcomes at a tertiary pediatric intensive care unit

Folafoluwa O Odetola1, Sarah J Clark, James G Gurney

  • 1Child Health Evaluation and Research Unit, Department of Pediatrics and Communicable Diseases, University of Michigan Health System, Ann Arbor, MI 48109, USA. fodetola@med.umich.edu

Journal of Critical Care
|March 31, 2009
PubMed

Insights

Interhospital transfer, especially from pediatric intensive care units (PICUs), increases resource use and can impact patient outcomes. Further research is needed to understand transfer decisions and severity factors.

Area of Science:

  • Pediatric Critical Care Medicine
  • Healthcare Resource Utilization
  • Patient Outcomes

Background:

  • Interhospital transfer is common for critically ill children requiring specialized care.
  • Understanding the impact of transfer on resource use and outcomes is crucial for healthcare planning.

Purpose of the Study:

  • To evaluate the effect of interhospital transfer on resource utilization and clinical outcomes in a tertiary pediatric intensive care unit (PICU).
  • To compare outcomes and resource consumption between direct admissions and various types of interhospital transfers (e.g., from emergency departments, wards, or other PICUs).

Main Methods:

  • Retrospective analysis of 2146 consecutive admissions for sepsis or respiratory failure to a PICU.
  • Data collected included demographics, admission source (direct vs. interhospital transfer), and clinical outcomes.
  • Admission sources were categorized as direct from the study hospital's emergency department (ED) or interhospital transfers from referring hospital EDs, wards, or PICUs.

Main Results:

  • Inter-PICU transfers showed higher crude mortality but not significantly different adjusted mortality compared to direct admissions.
  • Emergency department transfers had lower PICU mortality than direct ED admissions.
  • All transfer types, particularly inter-PICU transfers, were associated with significantly longer stays and increased use of intensive care technology (P < .01).

Conclusions:

  • Interhospital transfer, especially from PICUs, is linked to substantial hospital resource consumption, often correlating with initial illness severity.
  • Further prospective research is recommended to identify factors influencing pretransfer illness severity and the decision-making process for interhospital transfers.
Abstract

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