Interhospital Pediatric Patient Transfers—Factors Influencing Rapid Disposition After Transfer

Abstract

The objective of this study was to determine the incidence, demographics, and clinical course of pediatric patients rapidly discharged after transfer from outlying emergency departments (EDs) to a tertiary care pediatric ED (PED) with no additional diagnostic or therapeutic actions. All pediatric patient charts from July 2009 to June 2010 who were transferred from 31 outlying EDs to an academic PED were reviewed for patient demographics, (age, sex, race) diagnosis, and disposition (admission, discharge). Primary outcome of interest in this study was percentage of children younger than 18 years discharged home after transfer to the tertiary care center (PED) with no additional medical or surgical procedures. Primary outcomes in terms of transferring physician ED pediatric physician versus ED nonpediatric physician (ED-NPP) and transferring hospital type were also analyzed using Fisher exact test. Three hundred forty-two patients transferred from outlying EDs to PED during the study period met inclusion criteria. Sixty percent (207/342) of overall transfers were in the age group 5 years or younger. Respiratory illness (27.5%) was the most common condition in all transfers. Patients transferred from EDs staffed by nonpediatric physician were more likely to be discharged home without needing additional studies or procedures. Patients transferred from EDs staffed by pediatricians were more likely to be admitted or required additional diagnostic and/or therapeutic interventions before disposition. Pediatric patients transferred from outlying community EDs to a PED frequently required little or no additional care. Referring hospital ED type and physician training type are associated with the need for additional workup at the pediatric emergency room.