Revati Narawane, Dell Children's Medical Center of Central Texas, Austin, TX, United States; Shannon Martinez, The University of Texas Health Science Center at San Antonio Joe R. and Teresa Lozano Long School of Medicine, New Braunfels, TX, United States; Sanyukta Desai, Dell Children's Medical Center of Central Texas, Austin, TX, United States
Fellow Dell Children's Medical Center of Central Texas Austin, Texas, United States
Background: As hospitals increasingly close pediatric units, children seeking care at general emergency departments (EDs) are more often transferred to children’s hospitals to receive definitive care for common pediatric illnesses. Up to 40% of these transfers are potentially avoidable. It is not known if the referring facility’s ability to care for children is associated with potentially avoidable transfers (PATs). Objective: To examine the association between referring facility pediatric capabilities and potentially avoidable pediatric interfacility transfers. Design/Methods: This is a retrospective cohort study conducted at 29 referring (non-children’s) hospitals and 2 children’s hospitals. We will include all 0-18 year olds transferred to one of two children’s hospitals from August 2021-December 2023. Our primary outcome will be PATs, defined as any patient discharged home from the ED or inpatient service within 24 hours of admission without any specialized procedures. Referring facility characteristics will include presence of pediatric inpatient units, ICUs, medical/surgical subspecialties and advanced airway management systems. We will perform a univariate analysis using a chi square test to assess if referring facility characteristics have an association with potentially avoidable transfers. Multivariable logistic regression will also be performed to assess how multiple referring facility capabilities could potentially impact PATs.
Two separate IRBs were submitted to obtain data for this study, including 1) survey of referring facilities to assess their pediatric capabilities and 2) interfacility transfer patient outcomes obtained from destination hospital EHR between August 2021 and 2023. Both data sets have been collected. We will submit a new secondary use IRB to merge these collected datasets in November 2024 with expected approval by January 2025. Data analysis will be completed between February- April 2025. Our dataset includes 7141 total interfacility transfers within the study period, of which 71% were admitted and 29% were discharged from the ED.
