Organized interfacility transfer processes: an opportunity to improve pediatric emergency care

The objective of the study was to determine the proportion of hospitals with established guidelines and agreements for the interfacility transfer of seriously ill and injured children.

Paper- and Web-based survey tools were utilized by states to survey all hospitals with an emergency department. In addition, a content analysis was done on existing state mandates and regulations addressing interfacility transfer guidelines/protocols and agreements.

Thirty-six states/territories participated in the Web survey. Two-thousand fifty-one or 62% of hospitals returned the surveys. Although 54% of responding facilities had interfacility transfer guidelines, only 42% of facilities included language regarding transfer of children. Only 13% of hospitals had interfacility guidelines containing all recommended components. No defined interfacility transfer processes or guidelines were in place in 46% of the data-set hospitals.Responding hospitals had agreements for transfer of patients requiring specialty services only 59% of the time, although only 43% of agreements included language specific to pediatrics. Interfacility transfer agreements were lacking in 41% of responding facilities.Fourteen states have legislative mandates requiring interfacility transfer guidelines and agreements. Enactment of state mandates for interfacility transfer agreements and guidelines may influence this process, although these data do not support this, and more research is needed.

Organized processes for interfacility transfer of ill or injured children were not established for a sizable proportion of survey hospitals. Addressing this void may provide an opportunity to improve the emergency care of children.