Ability of hospitals to care for pediatric emergency patients

Athey, Jean; Dean, Jonathan; Ball, Jane W.; Wiebe, Robert A.; Melese-d'Hospital, I. A

doi:10.1097/00006565-200106000-00005

Cited by 122 publications

(78 citation statements)

References 12 publications

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“…Regionalization also contributes to the fact that rural and underserved hospitals and EDs frequently lack equipment, experience, and personnel with subspecialty training. 2,[34][35][36][37] The uneven distribution of resources and expertise 38,39 may explain some of our findings of varying odds of transfer for certain conditions, including pediatric cardiac services. 40,41 In summary, we found that pediatric patients without insurance or reported as having self-pay are statistically more likely to be transferred to another hospital for inpatient care than to be admitted locally compared with children with private insurance.…”

Section: Discussionmentioning

confidence: 99%

The Association Between Insurance and Transfer of Noninjured Children From Emergency Departments

Huang

Natale

Kissee

et al. 2017

Annals of Emergency Medicine

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Study objective: Among children requiring hospital admission or transfer, we seek to determine whether insurance is associated with the decision to either admit locally or transfer to another hospital.Methods: This cross-sectional study used Healthcare Cost and Utilization Project 2012 Nationwide Emergency Department Sample. Pediatric patients receiving care in emergency departments (EDs) who were either admitted or transferred were included. Clinical Classifications Software was used to categorize patients into noninjury diagnostic cohorts. Multivariable logistic regression models adjusting for potential confounders, including severity of illness and comorbidities, and incorporating nationally representative weights were used to determine the association between insurance and the odds of transfer relative to admission.Results: A total of 240,620 noninjury pediatric ED events met inclusion criteria. Patient and hospital characteristics, including older age and nonteaching hospitals, were associated with greater odds of transfer relative to admission. Patients who were uninsured or had self-pay had higher odds of transfer (odds ratio [OR] 3.84; 95% confidence interval [CI] 2.08 to 7.09) relative to admission compared with those with private insurance. Uninsured and self-pay patients also had higher odds of transfer across all 13 diagnostic categories, with ORs ranging from 2.96 to 12.00. Patients with Medicaid (OR 1.05; 95% CI 0.90 to 1.22) and other insurances (OR 1.14; 95% CI 0.87 to 1.48) had similar odds of transfer compared with patients with private insurance. Conclusion:Children without insurance and those considered as having self-pay are more likely to be transferred to another hospital than to be admitted for inpatient care within the same receiving hospital compared with children with private insurance. This study reinforces ongoing concerns about disparities in the provision of pediatric ED and inpatient care.

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Section: Discussionmentioning

confidence: 99%

The Association Between Insurance and Transfer of Noninjured Children From Emergency Departments

Huang

Natale

Kissee

et al. 2017

Annals of Emergency Medicine

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“…164,[176][177][178][179] This is especially true for infants and children with cardiovascular disease or illness. 180 In addition, the staff working in smaller, general EDs, including physicians, nurses, pharmacists, and support staff, are often less experienced in caring for children with congenital heart disease or other acquired cardiac conditions.…”

Section: Telecardiology In the Edmentioning

confidence: 99%

Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association

Satou¹,

Rheuban²,

Alverson³

et al. 2017

Circulation

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A dvancements in technology and broadband have revolutionized the current practice of medicine. The field of pediatric cardiology is no exception given the need for prompt diagnosis and reliance on cardiac imaging to identify infants and children with potentially life-threatening cardiovascular disease. As the relationship between telemedicine and pediatric cardiology has advanced, it has created a need to develop a broad, comprehensive document reviewing all the various aspects of telemedicine in pediatric cardiology. For more than a decade, a significant body of literature has been published describing individual experiences and practices, yet there remains no comprehensive statement or document summarizing this rapidly advancing field. In an effort to describe the collective experience and to provide structure and guidance for pediatric cardiology practitioners and healthcare providers, we have developed a scientific statement on the use of telemedicine in pediatric cardiology.Specific areas explored in this document include both neonatal and fetal teleechocardiography, implications for training community sonographers, pulse oximetry programs, qualitative improvement and appropriate use criteria initiatives, and remote electrophysiological monitoring. This document also includes teleconsultation and teleausculation, direct-to-consumer and home monitoring programs, and a look into the use of telemedicine and pediatric cardiology in the intensive care setting. Furthermore, a detailed review of the legislative, public policy, and legal aspects of telemedicine is provided, along with financial and reimbursement information.Several terms are used in the literature interchangeably; a brief explanation is provided to help readers of this document. The term telehealth is defined as the use of technology to bridge distances in any aspect of medicine; telemedicine is the specific application of technology to conduct clinical medicine at a distance. The term telecardiology is defined as the broad application of telemedicine in the field of cardiology specifically, and tele-echocardiography is the most common application used within this field. ECHOCARDIOGRAPHY AND TELEMEDICINEEchocardiography is the most commonly used noninvasive cardiovascular imaging modality and is considered to be both safe and cost-effective. Tele-echocardiography can be described as a process in which a provider or a technician obtains cardiovascular ultrasound images from a given patient and these images are subsequently transmitted to an offsite location where a cardiologist can provide further analysis and interpretation. Thus, tele-echocardiography enables expert interpretation and consultation in a rapid and potentially geographically disparate fashion, enabling prompt and accurate decision making involving triage, transport, and therapeutic priorities. Tele-echocardiography is now routinely used across the age and subspecialty spectrum in pediatric cardiology.

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“…16 It has been shown that it is more difficult to obtain a history and conduct an examination on an anxious child. 17 Environmental constraints can have potentially adverse outcomes, as highlighted in a Korean study, which showed a correlation between overcrowding in cEDs and increased mortality. 18 …”

Section: Emergency Department Environmentmentioning

confidence: 99%

Children are not young adults: a call for standardized guidelines for dealing with pediatric patients in the emergency department of Canadian community hospitals

Hamid

Siddiqui

Chandna³

et al. 2015

CJEM

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Ability of hospitals to care for pediatric emergency patients

Abstract: Emergent and critical care of infants and children may not be well integrated and regionalized within our health care system, suggesting that there is room for improvement in the quality of care for children encountering emergent illness and trauma.

Cited by 122 publications

References 12 publications

The Association Between Insurance and Transfer of Noninjured Children From Emergency Departments

The Association Between Insurance and Transfer of Noninjured Children From Emergency Departments

Telemedicine in Pediatric Cardiology: A Scientific Statement From the American Heart Association

Children are not young adults: a call for standardized guidelines for dealing with pediatric patients in the emergency department of Canadian community hospitals

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