Emergency and Definitive Care for Children in the United States: The Perfect Storm.

Abstract

* Abbreviations: ED — : emergency department HCI — : Hospital Capability Index In this issue of Pediatrics , Michelson et al1 quantified what many of us who practice pediatric emergency medicine have suspected: that many hospitals have reduced their pediatric inpatient capability, which has necessitated the need for children to be transferred for definitive care, often outside of their home communities. They further identified that hospitals with emergency departments (EDs) that care for few pediatric patients are least likely to offer inpatient services and that pediatric inpatient care is becoming concentrated in higher-volume urban centers, particularly primary pediatric facilities.1 In this study, the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample database from 2008 to 2016 was used to sample EDs nationally for admission rates and transfers. This sample represented 21.8 million pediatric ED visits in 2008 and 24.1 million visits in 2016. The ED-visit volume was stratified as low volume (<1800 visits), medium volume (1800–4999), medium-high volume (5000–9999), and high volume (≥10 000) on the basis of a similar ED-visit stratification schemata used by the National Pediatric Readiness Project.2–5 Primary pediatric facilities were further identified as those hospitals for … Address correspondence to Marianne Gausche-Hill, MD, FACEP, FAAP, FAEMS, Los Angeles County Emergency Medical Services Agency, 10100 Pioneer Blvd, Santa Fe Springs, CA 90670. E-mail: mgausche-hill{at}dhs.lacounty.gov