416 - Potentially Avoidable Transfers and Emergency Department Pediatric Readiness Scores

Publication Number: 416.6264

Isrealia Jado, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, United States; Hamy Temkit, Phoenix Children's Hospital, Phoenix, AZ, United States; Andrew Steinfeldt, Phoenix Children's Hospital, Phoenix, AZ, United States; Karen Yeager, Phoenix Children's, Phoenix, AZ, United States; Cherisse Mecham, Phoenix Children's Hospital, Phoenix, AZ, United States

Background: Pediatric visits to emergency departments (EDs) are common across the U.S., but significant variability in pediatric care capabilities often necessitates transfers to tertiary care pediatric institutions. Some of these ED-to-ED transfers are classified as potentially avoidable transfers (PATs), leading to unnecessary costs, delays, redundancies, and increased mortality risk. The National Pediatric Readiness Project (NPRP) aims to enhance pediatric capabilities in EDs and includes periodic readiness assessments. This study evaluates PAT rates from EDs to a single tertiary care pediatric ED from January 2017 to December 2020, examining correlations with their 2021 pediatric readiness survey scores.

Objective: Primary

Objective: Evaluate and describe PAT rates from EDs to a single tertiary pediatric ED from 01/2017 to 12/2020.
Secondary

Objective: Assess the correlation between each ED’s PAT rate and their 2021 NPRP pediatric readiness score.

Design/Methods: This IRB-approved, single-center, retrospective chart review analyzed transfer data for patients aged 0-18 from January 2017 to December 2020. PATs were defined as patients discharged within 24 hours without advanced procedures, in-person subspecialist consultations, or advanced imaging. Pediatric readiness scores were obtained from the Emergency Medical Services for Children (EMSC) data center. Descriptive statistics summarized PAT rates, and Pearson correlation assessed relationships between PAT rates and readiness scores.

Results: Among 14,152 patient encounters from 135 facilities, the mean PAT rate was 31.6%, with statistical significance noted across all four years (p=0.013). No correlation was found between PAT rates and readiness scores. However, facilities that completed the readiness survey demonstrated lower PAT rates compared to those that did not (25% vs. 30%, p=0.055).

Conclusion(s): Nearly a third of ED-to-ED transfers were potentially avoidable, with no correlation with the sending facility’s pediatric readiness score. Facilities engaged in the readiness survey process, however, exhibited a trend toward lower PAT rates, indicating that attention to pediatric readiness may positively impact care. Identifying factors contributing to PATs can inform community outreach, resource allocation, and areas needing medical direction support.

Potentially Avoidable Transfer Rates by Year
The mean potentially avoidable transfers rates listed by year, p=0.0125. 95% confidence intervals for each year respectively (31.4%,35.2%), (29.4%,32.4%), (31.2%,33.9%), and (28.3%,31.4%).