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Resource Utilization for Pediatric Patients Discharged After Interhospital Transfer
Natasha Bennett1, Monica Mansour2, Ahmad Farooqi3
1From the Department of Pediatrics, Children's Hospital of Michigan.
Insights
Most pediatric transfers to a pediatric emergency department (PED) from general emergency departments (EDs) required minimal resources before discharge. Community ED referrals showed higher resource use and procedure rates in the PED compared to academic EDs.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Systems Analysis
- Transfer Medicine
Background:
- Optimizing patient transfers to pediatric emergency departments (PEDs) from general emergency departments (EDs) is crucial.
- Understanding resource utilization in PEDs for transferred patients informs educational and resource needs in general EDs.
Purpose of the Study:
- To compare resource utilization in a pediatric emergency department (PED) for patients transferred from academic versus community general emergency departments (EDs).
- To identify differential educational and resource needs within general EDs based on transfer patterns to a PED.
Main Methods:
- Retrospective review of patients under 21 years old transferred to a PED and discharged home over one year.
- Categorization of referring institutions as academic or community EDs.
- Comparison of demographic and clinical variables, including resource utilization, between academic and community ED referrals.
Main Results:
- Of 5675 interfacility transfers, 1603 (28.2%) were discharged from the PED.
- Most patients (67.4%) originated from community EDs.
- Patients from community EDs had higher rates of procedures (44% vs 39%) and high resource utilization (61% vs 55%) in the PED compared to those from academic EDs, with no significant differences in laboratory testing, ancillary studies, or medication administration.
Conclusions:
- The majority of children transferred to a PED from general EDs require minimal resources prior to discharge.
- Differences in care patterns between academic and community ED referrals highlight distinct educational and resource requirements for general EDs managing pediatric patients.
Background:
Transfers to a pediatric emergency department (ED) with subsequent discharge home should be optimized. Transfers to a pediatric ED (PED) from community and academic general EDs are compared with a focus upon subsequent resource utilization with the PED to identify patterns of resource and education needs within general EDs.
Methods:
Patients younger than 21 years transferred to a PED from general EDs over a 1-year period and discharged home were retrospectively reviewed. The referring institutions were categorized as academic or community. Demographic and clinical variables reflecting PED care were abstracted and referrals from the academic and community institutions were compared.
Results:
Among 5675 interfacility transfers, 1603 (28.2%) were discharged home from the PED. Most patients were transferred from a community ED (n = 1081, 67.4%). Laboratory testing, ancillary studies, and medication administration did not differ between patients transferred from an academic or community ED. Patients from a community ED were more likely to have a procedure performed (44% vs 39%, P = 0.04). Patients from a community ED were also more likely to have high resource utilization in the PED (61% vs 55%, P = 0.03).
Discussion:
Most children transferred to a PED from a general ED required few resources in the PED before discharge home. The pattern of care delivered in the PED differed by the designation of the transferring ED providing insight into the differential educational and resource needs of general EDs in caring for pediatric patients.
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