Urban and Rural Patterns in Emergent Pediatric Transfer: A Call for Regionalization

Authors

  • Timothy Horeczko MD, MSCR,

    Corresponding author
    1. Department of Emergency Medicine, University of California, Davis, Sacramento, California
    2. Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
    • For further information, contact: Timothy Horeczko, MD, MSCR, Department of Emergency Medicine, Harbor-UCLA Medical Center, 1000 W Carson St, Box 21, Torrance, CA 90509; e-mail: thoreczko@emedharbor.edu.

    Search for more papers by this author
  • James P. Marcin MD, MPH,

    1. Department of Pediatrics, Division of Critical Care, University of California, Davis, Sacramento, California
    Search for more papers by this author
  • Jeremy M. Kahn MD, MS,

    1. Departments of Critical Care Medicine and Health Policy & Management, University of Pittsburgh, Pittsburgh, Pennsylvania
    Search for more papers by this author
  • Robert E. Sapien MD;,

    1. Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico
    Search for more papers by this author
  • on behalf of the Consortium Of Regionalization Efforts in Emergency Medical Services for Children (CORE-EMSC)

    Search for more papers by this author
    • CORE-EMSC members include Julie Rabeau, RN, EMSRN (Alaska); Tomi St Mars, RN, MSN, CEN, FAEN (Arizona); Marianne Gausche-Hill, MD, Timothy Horeczko, MD, MSCR, Larry Karsteadt, MS, Emily Kim, MPH, Nathan Kuppermann, MD, MPH, James Marcin, MD, MPH, Pamela Mather, BSN, Kenneth Stiver, MD, & Cheryl Wraa, RN, BSN, MSN (California); James DeTienne & Joseph D. Hansen (Montana); Robert E. Sapien, MD (New Mexico); and Jeremy M. Kahn, MD, MS, Scott Watson MD, MPH, Kathryn Felmet MD, Melinda Hamilton MD, MSc, & Richard Saladino MD (Pennsylvania).


  • 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.

Abstract

Context

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.

Purpose

To determine the epidemiology of pediatric transfers from urban and rural emergency departments (EDs).

Methods

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.

Findings

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).

Conclusions

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.

Ancillary