Emergency Department Pediatric Readiness and Potentially Avoidable Transfers

Abstract

Objective To determine the association between potentially avoidable transfers (PATs) and emergency department (ED) pediatric readiness scores and the score's associated components. Study designThis cross-sectional study linked the 2012 National Pediatric Readiness Project assessment with individual encounter data from California's statewide ED and inpatient databases during the years 2011-2013. A probabilistic linkage, followed by deterministic heuristics, linked pretransfer, and post-transfer encounters. Applying previously published definitions, a transferred child was considered a PAT if they were discharged within 1 day from the ED or inpatient care and had no specialized procedures. Analyses were stratified by injured and noninjured children. We compared PATs with necessary transfers using mixed-effects logistic regression models with random intercepts for hospital and adjustment for patient and hospital covariates.Results After linkage, there were 6765 injured children (27% PATs) and 18 836 noninjured children (14% PATs) who presented to 283 hospitals. In unadjusted analyses, a 10-point increase in pediatric readiness was associated with lower odds of PATs in both injured (OR 0.93, 95% CI 0.90-0.96) and noninjured children (OR 0.90, 95% CI 0.88-0.93). In adjusted analyses, a similar association was detected in injured patients (aOR 0.92, 95% CI 0.86-0.98) and was not detected in noninjured patients (aOR 0.94, 95% CI 0.88-1.00). Components associated with decreased PATs included having a nurse pediatric emergency care coordinator and a quality improvement plan.Conclusions Hospital ED pediatric readiness is associated with lower odds of a PAT. Certain pediatric readiness components are modifiable risk factors that EDs could target to reduce PATs.

Trends in pediatric emergency department transfers from Indian Health Service and tribal health systems

“…a Generalized estimating equations (GEE) model using year as a factor to account for within-subject variability across the years 2017-2020. Diagnostic categories within this population are similar to prior studies of non-IHS and tribal EDs, including those in rural settings, with most pediatric patients being transferred for respiratory concerns, injuries, poisonings, or gastrointestinal or neurologic concerns 5,15,20,21. Respiratory concerns accounted for 18.9%-26.7% of transfers and 39% of these (199/507) were discharged directly from the receiving ED suggesting a potential area for pediatric readiness initiatives geared toward quality improvement and enhancedTA B L E 3Generalized estimating equations (GEE) model using year and age as factors to account for within-subject variability across the years 2017-2020.Abbreviations: ICU, intensive care unit; IHS, Indian Health Service; LOS, length of stay.TA B L E 4 Top 5 diagnostic categories by year.…”

“…It is possible that this is secondary to a reduced number of pediatric-trained providers and ancillary staff in the community setting. 12 There was a significant increase in transfers in the 15 [13][14][15][16][17] IHS and tribal EDs have previously scored an average of 60.9/100 (lower than the national average) on assessments of pediatric readiness and noted areas of improvement within these systems have included quality improvement, stocking of pediatricspecific equipment, policies and procedures for interfacility transport, and maintaining staff pediatric competencies. 10,18 Our study highlights potential targets for maximal impact for interventions aiming to enhance pediatric readiness in IHS and tribal EDs.…”

“…Following the implementation of the National Pediatric Readiness Project in 2009, studies have demonstrated that EDs with higher pediatric readiness scores are associated with lower mortality for injured children, lower rates of potentially avoidable transfers, and a reduction in mortality for children presenting with critical illness 13–17 . IHS and tribal EDs have previously scored an average of 60.9/100 (lower than the national average) on assessments of pediatric readiness and noted areas of improvement within these systems have included quality improvement, stocking of pediatric‐specific equipment, policies and procedures for interfacility transport, and maintaining staff pediatric competencies 10,18 .…”

Prehospital and emergency department pediatric readiness for injured children: A statement from the American College of Surgeons Committee on Trauma Emergency Medical Services Committee

“…23 The designation of a PECC seems to be instrumental in achieving a higher score, and centers with high PR have lower likelihood to transfer patients. 24,25 More recently, data from the NPRP and National Trauma Databank have been combined to evaluate the association of PR, trauma designation, and WPRS on mortality and complications. This study found a pediatric trauma mortality rate of 1.5% and complication rate of 1.3%, which were both significantly lower in higher WPRS centers (odds ratio, 0.58 and 0.88, respectively).…”

“…State-based questionnaires specific to the comfort of emergency professionals with pediatric trauma resuscitation procedures and protocols have demonstrated significant gaps in the PR of nontrauma centers 23 . The designation of a PECC seems to be instrumental in achieving a higher score, and centers with high PR have lower likelihood to transfer patients 24,25 . More recently, data from the NPRP and National Trauma Databank have been combined to evaluate the association of PR, trauma designation, and WPRS on mortality and complications.…”