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Emergency Transfers Are Associated With Increased Financial Charges

Sanjiv D Mehta1,2, Meghan Galligan3,4,5, Jonathan Race6

  • 1Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Hospital Pediatrics
|December 4, 2025
PubMed

Insights

Pediatric emergency transfers (ETs) significantly increase hospital charges for children. Investing in systems to prevent these unplanned intensive care unit (ICU) transfers is crucial for both clinical and financial reasons.

Area of Science:

  • Pediatric critical care medicine
  • Healthcare economics
  • Hospital administration

Background:

  • Pediatric emergency transfers (ETs) are unplanned intensive care unit (ICU) transfers requiring immediate critical interventions.
  • ETs are linked to increased mortality and prolonged hospital stays.
  • The financial implications of pediatric ETs remain largely unquantified.

Purpose of the Study:

  • To compare the post-transfer financial charges associated with pediatric emergency transfers (ETs) versus non-ETs.
  • To determine the economic burden of ETs in a pediatric hospital setting.

Main Methods:

  • A retrospective cohort study analyzed 2034 ICU transfers from 2015-2019 at a children's hospital.
  • Compared aggregate and daily post-transfer charges (ICU and total hospital) between ETs and non-ETs.
  • Adjusted for patient factors (age, chronic conditions) and transfer characteristics (LOS, service, deterioration type) using regression models.

Main Results:

  • ETs were associated with significantly higher unadjusted and adjusted post-transfer charges.
  • Adjusted increases in charges for ETs were 65% for ICU, 49% for total hospital stay, and 20% daily.
  • Charge increases varied by originating service and type of deterioration, with respiratory ETs showing the highest cost increase.

Conclusions:

  • Pediatric emergency transfers (ETs) represent a substantial financial burden on hospitals.
  • The findings underscore the economic necessity of implementing preventative strategies to reduce ETs.
  • Reducing ETs can yield significant cost savings alongside improved patient outcomes.
Abstract

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