137 - When EMS Bypasses a Closer Hospital and Transports to a Tertiary Pediatric Emergency Department: Patient Diagnoses, Interventions and Dispositions

Publication Number: 137.7012

Holly Rose, Indiana University School of Medicine, Plainfield, IN, United States; Matthew Hays, Indiana University School of Medicine, Indianapolis, IN, United States; Gregory W. Faris, Indiana University School of Medicine, Indianapolis, IN, United States; Nancy Glober, Indiana University School of Medicine, Indianapolis, IN, United States

Background: The national EMS (Emergency Medical Services) staffing shortage can increase response times and reduce ambulance coverage. Bypass of the closest emergency department (ED) for a specialist care center may exacerbate those challenges. Little is known about how often a general hospital is bypassed by EMS in favor of transport to a pediatric ED (PED) and when those bypasses are appropriate.

Objective: Our study describes pediatric patient outcomes after EMS transport from the scene to a PED, bypassing a closer general hospital.

Design/Methods: This is a one-year retrospective chart review of patients less than 18 years of age transported by EMS from the scene to the PED of a pediatric Level 1 trauma and burn center after bypassing a closer general hospital. Data included all pediatric transports in 2022 completed by a single EMS agency to the PED. Geospatial analysis was used to determine distance and duration of bypasses. Hospitals within three miles of the PED were excluded from analysis as well as EMS transport duration less than two minutes. Patients with a primary EMS complaint of trauma were also excluded. Patient demographics, ICD-10 diagnoses, utilization of laboratory or radiology resources, intravenous (IV) line placement, IV medication administration, and ED disposition were collected. We performed descriptive analysis of patients who did not receive ED interventions and were also discharged from the ED. We identified the most common ICD-10 diagnosis codes associated with those encounters.

Results: There were a total of 2323 patients included. Of those, 2304 (99.2%) bypassed a closer hospital to get to the PED. Of the bypass encounters, 714 patients (31.0%) were discharged from the PED and received no interventions (no IV placement or IV medications, no laboratory work, no radiographic imaging). The most common ICD-10 diagnoses of those patients were convulsions (n=111, 15.5%), Encounter for observation and examination for conditions ruled out (n=70, 10.0%), and Respiratory signs and symptoms (n=40, 5.6%).

Conclusion(s): This retrospective review showed that pediatric patients were often taken to a PED when a closer general ED may have been appropriate. Future investigation should further describe EMS provider decision-making in selecting a destination. This could be used to target EMS educational initiatives for appropriate hospital bypasses and thus possibly reduce already scarce EMS resources.