Potentially Avoidable Emergency Department Transfers for Acute Pediatric Respiratory Illness

Area of Science:

• Pediatric Emergency Medicine
• Healthcare Quality Improvement
• Respiratory Illness Management

Background:

• Acute pediatric respiratory illness frequently leads to emergency department (ED) transfers.
• Predictors of potentially avoidable transfers (PATs) in this population are not well-understood.
• This study investigates patterns and predictors of PATs in children with acute respiratory illness.

Purpose of the Study:

• To characterize patterns of potentially avoidable emergency department (ED) transfers for pediatric respiratory illness.
• To identify predictors associated with potentially avoidable transfers (PATs) in children.

Main Methods:

• Cross-sectional analysis of over 8 million pediatric ED visits (2018-2019).
• Included transfers for pneumonia, croup/URI, bronchiolitis, or asthma.
• Potentially avoidable transfers (PATs) defined as discharge from the receiving ED or within 24 hours of admission without specialized procedures.

Main Results:

• 25.5% of matched respiratory transfers were potentially avoidable.
• Transfers for croup/other upper respiratory infection (URI) had a higher likelihood of being potentially avoidable (OR 2.72).
• Transfers originating from high-volume pediatric EDs were less likely to be potentially avoidable (OR 0.48).

Conclusions:

• Pediatric respiratory transfers for croup/URI are most likely to be potentially avoidable.
• Future efforts to reduce PATs should target croup management in lower-volume EDs.