Appropriateness of Pediatric Orthopaedic Transfers to a Level 1 Hospital

McKenna, Jaclyn; Novikov, Dmitry S.; Pawlak, Amanda; Park, Jihye; Yang, Jie; Iyer, Hariharan; Barsi, James

doi:10.1097/bot.0000000000001220

Cited by 2 publications

(2 citation statements)

References 10 publications

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“…8 McKenna et al compared pediatric patients with orthopaedic injuries who presented directly to their hospital to those who were transferred from other facilities. 11 They found that transfer patients were likely to have higher injury severity scores and were likely to occur in the evening or night (though the time of actual injury was not specified). Approximately 30% of their transfers were deemed inappropriate.…”

Section: Discussionmentioning

confidence: 99%

Inappropriate Pediatric Orthopaedic Emergency Department Transfers: A Burden on the Health Care System

Cao,

Hull,

Elliott

et al. 2024

Journal of Pediatric Orthopaedics

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Background: Though the importance of level 1 pediatric trauma has repeatedly been shown to lessen both morbidity and mortality in critically injured children, these same tertiary referral centers also receive numerous transfers of patients with less severe injuries. This not only leads to increased costs and use of limited facility resources but, oftentimes, frustration and unnecessary expense to those families for whom transfer was avoidable. Prior work has demonstrated that half of all inappropriate pediatric interfacility transfers are due to orthopedic injuries. This study aims to evaluate the incidence of inappropriate transfers of pediatric patients with isolated orthopedic injuries to a pediatric level 1 trauma center and identify factors associated with such transfers. Methods: All patients transferred to a large metropolitan level 1 pediatric trauma center for isolated orthopedic injuries over a 6-year period were retrospectively evaluated. Medical records were reviewed for demographic and injury data, including age, gender, race, social deprivation index, insurance status, location of transferring institution, timing of transfer, and availability of orthopedic on-call coverage at transferring institution. The transfer was deemed to be appropriate if the patient required a sedated reduction, was admitted to the hospital, or was taken to the operating room within 24 hours of transfer. Regression analysis was reviewed for each of the demographic, patient, and transfer characteristics in an attempt to isolate those associated with inappropriate transfer. Results: In all, 437 transfers occurred during the study period. Of these, 112 (26%) were deemed inappropriate. 4% of patients transferred for orthopedic injuries did not receive an orthopedic consult following the transfer. Non-white patients were more likely than white patients to be transferred inappropriately (34.01% vs. 21.58%, P=0.009). No other demographic characteristic was predictive of inappropriate transfer. There was no difference in the rate of appropriate transfer between patients with private insurance versus government-funded, self-paying, or uninsured patients. The timing of transfer (night vs. day and weekday vs. weekend) did not affect the appropriateness of transfer. Facilities with orthopaedic on-call coverage were more likely to inappropriately transfer patients than those without (26.6% vs. 23.4%, P<0.001). Conclusion: A quarter of patients transferred for isolated orthopaedic injuries were inappropriately transferred. Unlike studies published in adult literature, the timing of transfer (overnight and weekend) and the insurance status of the patient did not appear to play a role in the appropriateness of transfer. Inappropriate and unnecessary trauma transfers create a significant burden on tertiary referral centers. Raising awareness of the high incidence of unnecessary transfers coupled with enhanced education of outside emergency medicine providers may result in better stewardship of health care resources, limit delays in patient care, and reduce strain on both the health care delivery system and the families of injured children. Level of Evidence: Level III—Therapeutic Study.

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Section: Discussionmentioning

confidence: 99%

Inappropriate Pediatric Orthopaedic Emergency Department Transfers: A Burden on the Health Care System

Cao,

Hull,

Elliott

et al. 2024

Journal of Pediatric Orthopaedics

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“…Pediatric orthopaedic patients with government-funded health insurance experience longer periods of time before receiving definitive treatment compared with commercially-insured patients at a national level. 1 2 3 4 5 6 , 9 , 19 20 21 22 23 24 The current literature successfully identifies these issuess but has been unable to determine why the issue exists or provide solutions that generate meaningful change. Our study attempts to localize this issue based on the timeline of care.…”

Section: Discussionmentioning

confidence: 99%

Inequalities in Pediatric Fracture Care Timeline Based on Insurance Type

et al. 2020

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Introduction: Socioeconomic and insurance status are often linked with limited access to health care. Despite several government-funded projects aimed at curtailing these barriers, pediatric orthopaedic patients continue to experience delays in receiving timely care for fracture treatments. This delay has been well-identified within the orthopaedic literature but, to our knowledge, has never been characterized based on timeline. Thus, the goal of this study is to evaluate the role of ethnicity, socioeconomic status, and insurance type on the timeline of pediatric patients to obtain orthopaedic care within our community. Methods: Pediatric patients presenting to our clinic for the treatment of one of 21 most common fractures were included. Patient demographics and the timeline of patient care were collected by retrospective chart review. Results: Government-funded insurance accounted for 60.6% of the 413 patients. These patients experienced significant ( P < 0.001) delays in access to care when compared with commercial insurance patients; the time between injury and referral as well as the overall time from injury to orthopaedic evaluation was 2.8 and twofold greater at 4.4 days and 9.2 days, respectively. A strong correlation was established between income levels and insurance type. Discussion: Pediatric patients with a lower socioeconomic status are more likely to rely on government-funded insurance and experience delays in fracture evaluation.

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Appropriateness of Pediatric Orthopaedic Transfers to a Level 1 Hospital

Abstract: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 2 publications

References 10 publications

Inappropriate Pediatric Orthopaedic Emergency Department Transfers: A Burden on the Health Care System

Inappropriate Pediatric Orthopaedic Emergency Department Transfers: A Burden on the Health Care System

Inequalities in Pediatric Fracture Care Timeline Based on Insurance Type

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