Clinical question: What are the characteristics of interfacility transfers to pediatric academic EDs?
Background: The majority of pediatric ED visits (89%) and hospital admissions (69%) occur via general hospital EDs, not freestanding academic children's hospitals. Pediatric hospitalists often provide consultation services in these community hospital settings and might be the primary admitting team in either setting (community hospital or children's hospital). Questions concerning the quality of pediatric ED care in community hospitals have been raised, with acknowledged improvements in post-transfer care for critically ill patients. The characteristics of less acutely ill transfers are unknown and could provide insight into opportunities for improvement.
Study design: Cross-sectional, retrospective database review.
Setting: Twenty-nine tertiary-care pediatric hospitals.
Synopsis: The Pediatric Health Information System (PHIS) database of the Child Health Corporation of America was reviewed; over a one-year period, 24,905 interfacility transfers were identified from 29 hospitals. Fifty-eight percent of patients were admitted for more than 24 hours with common respiratory illnesses (pneumonia, bronchiolitis, asthma) and surgical conditions representing the most common diagnostic categories. Among the remaining patients, 24.7% were discharged directly from the academic pediatric EDs; 17% were admitted for less than 24 hours. Among those discharged or briefly admitted, common nonsurgical diagnostic categories included abdominal pain, viral gastroenteritis/dehydration, and other gastrointestinal conditions.
The authors attempted to define areas for improvement in pediatric care in community hospital EDs. Limitations of their analysis include the use of a database without validated code for source of admission, as well as an inability to drill down further into the specifics of what additional expertise was provided at the pediatric EDs. However, this study provides a platform by which pediatric hospitalists can view and subsequently improve the value of their regional care systems.
Bottom line: Interfacility transfers to pediatric academic EDs might offer an opportunity for improved pediatric care in community hospital EDs.
Citation: Li J, Monuteaux MC, Bachur RG. Interfacility transfers of noncritically ill children to academic pediatric emergency departments. Pediatrics. 2012;130:83-92.
Reviewed by Pediatric Editor Mark Shen, MD, SFHM, medical director of hospital medicine at Dell Children's Medical Center, Austin, Texas.