Characterizing Avoidable Transfer Admissions in Infants Hospitalized for Bronchiolitis.

Area of Science:

• Pediatric critical care
• Respiratory infections
• Healthcare systems research

Background:

• The necessity of transferring infants with bronchiolitis to pediatric centers is often unclear.
• Understanding avoidable transfers is crucial for optimizing resource allocation and patient care pathways.
• This study investigates the characteristics and predictors of potentially unnecessary interfacility transfers for bronchiolitis.

Purpose of the Study:

• To characterize avoidable interfacility transfer admissions for infants hospitalized with bronchiolitis.
• To test the hypothesis that a higher proportion of transferred infants are discharged within 48 hours with minimal intervention compared to direct admissions.

Main Methods:

• A prospective cohort study of 1007 infants (<1 year) hospitalized for bronchiolitis across 17 centers (2011-2014).
• An 'avoidable transfer admission' was defined as hospitalization <48 hours without interventions for severe illness where pediatric specialists are beneficial.
• Multivariable logistic regression identified factors associated with avoidable transfer admissions, comparing transfer and non-transfer groups.

Main Results:

• Of 1007 infants, 164 (16%) were transfer admissions. Fewer transferred infants (24%) were hospitalized <48 hours with minimal intervention compared to non-transferred infants (36%) (P = .007).
• Avoidable transfer admissions were more common in children of color, those with non-private insurance, and transfers from small emergency departments (EDs).
• Minority race/ethnicity, normal oxygenation, and small ED origin independently predicted higher odds of avoidable transfer admission.

Conclusions:

• While most transferred infants with bronchiolitis require significant interventions, approximately 25% of transfer admissions may be potentially avoidable.
• Factors such as patient demographics and originating ED size are associated with avoidable transfers, highlighting areas for improved care coordination.
• Further research should focus on refining transfer criteria and improving primary care or community ED management of bronchiolitis to reduce unnecessary transports.