Association of Subspecialty and Intensive Care Capabilities With Emergency Department Transfer

Area of Science:

• Pediatric Emergency Medicine
• Healthcare Systems Research

Background:

• Pediatric emergency department (ED) transfers are rising, even in hospitals with pediatric admitting capabilities.
• This trend necessitates understanding factors contributing to these transfers.

Purpose of the Study:

• To investigate the association between pediatric subspecialty and pediatric intensive care unit (PICU) capabilities and ED transfer rates.
• To identify factors influencing pediatric ED transfers in hospitals with admitting capabilities.

Main Methods:

• Retrospective cross-sectional study using the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample database.
• Analysis of pediatric ED visits resulting in admission or transfer at hospitals with pediatric admitting capability.
• Logistic regression used to assess the impact of pediatric subspecialty and PICU availability on transfer rates.

Main Results:

• Hospitals lacking pediatric subspecialty care had significantly higher transfer rates (42.4%) compared to those with all three subspecialties (2.6%).
• Hospitals without pediatric intensive care unit (PICU) capability had a 41.7% transfer rate, versus 7.0% for those with PICU capability.
• Lack of subspecialty care showed a stronger association with increased transfers than lack of PICU capability.

Conclusions:

• Both pediatric subspecialty and PICU capabilities are associated with lower ED transfer rates among hospitals with pediatric admitting capabilities.
• Subspecialty availability demonstrated a more substantial impact on reducing transfers.
• Interventions aimed at reducing pediatric transfers should consider enhancing access to pediatric subspecialty services.