WIP 35 - Impact of location and capabilities of a referring facility on diagnostic discordance in pediatric patients transferred to a pediatric intensive care unit

Publication Number: WIP 35.7454

Ingrid Frydson, Emory University School of Medicine, Atlanta, GA, United States; Lindsay R. Jaeger, Children’s Healthcare of Atlanta, Atlanta, GA, United States; Michael Gibbs, Children's Healthcare of Atlanta, Atlanta, GA, United States; Eva Bozeman, Children’s Healthcare of Atlanta, Decatur, GA, United States; Prakadeshwari Rajapreyar, Children’s healthcare of Atlanta, Brookhaven, GA, United States

Background: High-quality care relies on a timely diagnosis to appropriately manage the patient. Interfacility transports represent a high-risk transition of care, where breakdowns in the diagnostic process can occur and impact patient care.
Pediatric literature has shown that diagnostic discordance among patients transferred from outside hospitals to a oediatric critical care unit (PICU) is associated with higher mortality rates, more in-transit events, and longer ICU and hospital length of stay (LOS).
Our PICU serves a large population in the state of Georgia with > 1500 patient transfers per year. An understanding of diagnostic discordance by geographic location might impact triaging of patients and alter guidance provided by the accepting physicians during transport. This type of study would also have the ability to impact outreach education efforts by our hospital and the transport team.

Objective: To determine the factors contributing to diagnostic discordance in patients transferred from surrounding rural and urban facilities to a quaternary PICU in Georgia, by a pediatric specialized critical care transport team.

Design/Methods: A retrospective chart review of patients transferred from urban and rural facilities within Georgia to the PICU during January 2023 until December 2023, will be performed. Diagnostic discordance by geographical location and institutional capability will be analyzed as our primary outcome. Secondary outcome measures include diagnostic discordance in transferred patients, ICU and hospital LOS, mortality,need for life sustaining medical interventions during transport and during first 6 hours of admission to the PICU. Discordant diagnosis will be subcategorized by system groups. Appropriate statistical analysis will be done through comparison testing.