Factors Associated With Emergency Department Discharge After Pediatric Interhospital Transport

Walls, Theresa A.; Chamberlain, James M.; Klein, Bruce L.

doi:10.1097/pec.0000000000000326

Cited by 24 publications

(18 citation statements)

References 18 publications

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“…However, transfers from these hospitals were less likely to be probably avoidable compared to facilities with no pediatric‐specific capabilities. This finding aligns with previous work that potentially avoidable transfers occur less commonly when patients are transferred from EDs staffed by physicians with pediatric training . Together, this body of work suggests that expanding local pediatric expertise and resources may reduce both overall transfers and probably avoidable transfers.…”

Section: Discussionsupporting

confidence: 86%

Referring Hospital Characteristics Associated With Potentially Avoidable Emergency Department Transfers

Ray

Marin

et al. 2018

Academic Emergency Medicine

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Among pediatric emergency transfers in a large state Medicaid program with a nearly 20% probably avoidable transfer rate, there was significant hospital-level variation in the proportion of probably avoidable transfers. Transfers from hospitals in large metropolitan areas and transfers from hospitals without pediatric-specific capabilities had increased odds of being probably avoidable transfers, such that these hospitals may represent targets for interventions to reduce these transfers.

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Section: Discussionsupporting

confidence: 86%

Referring Hospital Characteristics Associated With Potentially Avoidable Emergency Department Transfers

Ray

Marin

et al. 2018

Academic Emergency Medicine

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“…Sometimes, pediatric patients and their families are subjected to lengthy and risky transports because of a systematic tendency to "over-triage" children because of the potential need for pediatric specialty services (75). In fact, the transfer of some pediatric patients to a pediatric referral center is often not necessary if there is a closer hospital with adequate pediatric capabilities, such as a pediatric ward or intermediate pediatric or neonatal intensive care unit (NICU) with pediatric expertise (76,77).…”

Section: Inpatient Care Unitsmentioning

confidence: 99%

Addressing health disparities in rural communities using telehealth

2015

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The regionalization of pediatric services has resulted in differential access to care, sometimes creating barriers to those living in underserved, rural communities. These disparities in access contribute to inferior healthcare outcomes among infants and children. We review the medical literature on telemedicine and its use to improve access and the quality of care provided to pediatric patients with otherwise limited access to pediatric subspecialty care. We review the use of telemedicine for the provision of pediatric subspecialty consultations in the settings of ambulatory care, acute and inpatient care, and perinatal and newborn care. Studies demonstrate the feasibility and efficiencies gained with models of care that use telemedicine. By providing pediatric subspecialty care in more convenient settings such as local primary care offices and community hospitals, pediatric patients are more likely to receive care that adheres to evidence-based guidelines. In many cases, telemedicine can significantly improve provider, patient, and family satisfaction, increase measures of quality of care and patient safety, and reduce overall costs of care. Models of care that use telemedicine have the potential to address pediatric specialists' geographic misdistribution and address disparities in the quality of care delivered to children in underserved communities.

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“…One such factor that influences an ED's readiness to care for children is the volume of pediatric patients. 17 Previous studies have revealed that children transferred from lowervolume EDs are more likely to be discharged from the receiving ED 17,18 ; therefore, it is possible that more transfers from lower-volume EDs are potentially avoidable and that lower-volume EDs may be more likely to transfer children with all conditions. Accordingly, our objectives were to assess how the likelihood of definitive care has changed over time for pediatric patients presenting to the ED with 3 common conditions: asthma, croup, and gastroenteritis.…”

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confidence: 99%

Trends in Regionalization of Emergency Care for Common Pediatric Conditions

2020

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BACKGROUND: For children who cannot be discharged from the emergency department, definitive care has become less frequent at most hospitals. It is uncertain whether this is true for common conditions that do not require specialty care. We sought to determine how the likelihood of definitive care has changed for 3 common pediatric conditions: asthma, croup, and gastroenteritis. METHODS:We used the Nationwide Emergency Department Sample database to study children ,18 years old presenting to emergency departments in the United States from 2008 to 2016 with a primary diagnosis of asthma, croup, or gastroenteritis, excluding critically ill patients. The primary outcome was referral rate: the number of patients transferred among all patients who could not be discharged. Analyses were stratified by quartile of annual pediatric volume. We used logistic regression to determine if changes over time in demographics or comorbidities could account for referral rate changes. RESULTS:Referral rates increased for each condition in all volume quartiles. Referral rates were greatest in the lowest pediatric volume quartile. Referral rates in the lowest pediatric volume quartile increased for asthma (13.6% per year; 95% confidence interval [CI] 5.6%-22.2%), croup (14.8% per year; 95% CI 2.6%-28.3%), and gastroenteritis (16.4% per year; 95% CI 3.5%-31.0%). Changes over time in patient age, sex, comorbidities, weekend presentation, payer mix, urban-rural location of presentation, or area income did not account for these findings.CONCLUSIONS: Increasing referral rates over time suggest decreasing provision of definitive care and regionalization of inpatient care for 3 common, generally straightforward conditions.

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Factors Associated With Emergency Department Discharge After Pediatric Interhospital Transport

Cited by 24 publications

References 18 publications

Referring Hospital Characteristics Associated With Potentially Avoidable Emergency Department Transfers

Referring Hospital Characteristics Associated With Potentially Avoidable Emergency Department Transfers

Addressing health disparities in rural communities using telehealth

Trends in Regionalization of Emergency Care for Common Pediatric Conditions

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