Urban and Rural Patterns in Emergent Pediatric Transfer: A Call for Regionalization
Funding: The Consortium Of Regionalization Efforts in Emergency Medical Services for Children (CORE-EMSC) is supported in part by the Health Resources and Services Administration, Maternal and Child Health Bureau, EMSC Program through the following State Partnership Regionalization of Care grant programs: H3AMC24071 (Alaska), H3AMC24072 (Arizona), H3AMC24073 (California), H3AMC24074 (Montana), H3AMC24075 (New Mexico), and H3AMC24076 (Pennsylvania).
Disclosures: The authors have no financial relationships relevant to this article to disclose.
Acknowledgments: We would like to thank Larry Karsteadt, MA, and Cheryl Wraa, RN, BSN, MSN, for their invaluable in-the-field perspective and input in the manuscript. Marianne Gausche-Hill, MD, and Nathan Kuppermann, MD, MPH, were integral in the groundwork for this group and this study; their tireless efforts to improve emergency care for children are an inspiration to us all. We thank Elizabeth Edgerton, MD, MPH, Theresa Morrison-Quinata, EMT, and Tasmeen Weik, DrPH, for their review of the manuscript, for their outstanding work in improving emergency medical care for children, and for their support of CORE-EMSC.
National groups call for the regionalization of health care, to direct patients with high-risk conditions to designated hospitals with greater capabilities. Currently there is limited information detailing the characteristics and specific needs of acutely ill and injured children who require transfer to another institution, especially in underserved rural communities.
To determine the epidemiology of pediatric transfers from urban and rural emergency departments (EDs).
We analyzed data in the National Hospital Ambulatory Medical Care Survey from 1995 to 2010. Eligible children were <18 years of age seen in a United States ED, and transferred to another hospital after initial evaluation.
Of all 283,232,058 pediatric ED visits, less than 0.5% resulted in a transfer, yielding a population-based estimate of 900,100 transfers nationally during this period. Urban and rural EDs showed similar transfer rates. Children transferred from rural EDs were older and more likely to arrive by emergency medical services than children transferred from urban EDs (12.1 vs 8.2 years of age, P < .01). Children from rural EDs were more than twice as likely to be transferred for a psychiatric indication (43.5% vs 19.5%, P < .01).
Emergency pediatric transfers are uncommon in the United States; transfer rates are similar in urban and rural settings. Rural children have additional obstacles to care, especially in access to emergency mental health services. Programs to study and implement regionalization of care should consider diverse patient populations and target improvement in coordination of care, transfer times, and outcomes.