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Characteristics of Pediatric Patient Transfers From General Emergency Departments in California From 2005 to 2018
Moon O Lee1, Jessica Wall2, Olga Saynina3
1From the Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA.
Insights
Pediatric emergency department transfers increased over time, particularly from general hospitals without pediatric intensive care units. Complex conditions like mental illness were more likely to be transferred, highlighting a need for improved transfer protocols.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Hospital Administration
Background:
- Annually, around 300,000 pediatric patients are transferred from emergency departments (EDs).
- These transfers can impact care quality, resource utilization, and healthcare costs.
- Understanding factors influencing pediatric ED transfers is crucial for optimizing patient care and resource allocation.
Purpose of the Study:
- To identify hospital characteristics associated with pediatric emergency department transfers.
- To analyze patient demographics and conditions linked to ED transfers.
- To examine the trend of pediatric ED transfers over time.
Main Methods:
- Retrospective cohort study utilizing California emergency department data from 2005-2018.
- Hospitals were classified by their inpatient pediatric capabilities.
- Patient data included demographics and Clinical Classifications Software diagnostic categories; regression models assessed transfer likelihood.
Main Results:
- Over 38 million pediatric visits were analyzed, with transfer rates ranging from 1% to 2%.
- Pediatric transfers increased, while admissions decreased across all hospital types during the study period.
- Transfers were significantly more likely from general hospitals lacking pediatric intensive care units (PICUs) and for conditions including mental illness, circulatory, and nervous system diseases.
Conclusions:
- Emergency departments in general hospitals without PICUs and specific patient diagnostic categories are associated with higher transfer likelihoods.
- A greater proportion of pediatric patients with complex conditions are transferred compared to those with common ailments.
- General EDs should consider developing specialized transfer processes for critically ill pediatric patients.
Objective:
Each year, approximately 300,000 pediatric patients are transferred out of emergency departments (EDs). Emergency department transfers may not only provide a higher level of care but also incur increased resource use and cost. Our objective was to identify hospital characteristics and patient demographics and conditions associated with ED transfer as well as the trend of transfers over time.
Methods:
This was a retrospective cohort study of pediatric visits to EDs in California using the California Office of Statewide Health Planning and Development ED data set (2005-2018). Hospitals were categorized based on inpatient pediatric capabilities. Patients were characterized by demographics and Clinical Classifications Software diagnostic categories. Regression models were created to analyze likelihood of outcome of transfer compared with admission.
Results:
Over the 14-year period, there were 38,117,422 pediatric visits to 364 EDs in California with a transfer rate of 1% to 2%. During this time, the overall proportion of pediatric transfers increased, whereas pediatric admissions decreased for all hospital types. Transfers were more likely in general hospitals without licensed pediatric beds (odds ratio [OR], 16.26; 95% confidence interval [CI], 15.87-16.67) and in general hospitals with licensed pediatric beds (OR, 3.54; 95% CI, 3.46-3.62) than in general hospitals with pediatric intensive care unit beds. Mental illness (OR, 61.00; 95% CI, 57.90-63.20), poisoning (OR, 11.78; 95% CI, 11.30-12.30), diseases of the circulatory system (OR, 6.13; 95% CI, 5.84-6.43), diseases of the nervous system (OR, 4.61; 95% CI, 4.46-4.76), and diseases of the blood and blood-forming organs (OR, 3.21; 95% CI, 3.62; 95% CI, 3.45-3.79) had increased odds of transfer.
Conclusion:
Emergency departments in general hospitals without pediatric intensive care units and patients' Clinical Classifications Software category were associated with increased likelihood of transfer. A higher proportion of patients with complex conditions are transferred than those with common conditions. General EDs may benefit from developing transfer processes and protocols for patients with complex medical conditions.
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