How can hospitals prevent unnecessary transfers of severely ill pediatric patients?

A study has found that not only personal variables, such as the severity of the disease, but also the situation and level of the emergency medical institutions significantly affect the transfer of pediatric patients with severe emergency cases.

Therefore, it emphasized that the government should support establishing a pediatric emergency medical system and a patient transfer system to reduce unnecessary transfers.

A team of researchers from the National Medical Center (NMC) Central Emergency Medical Center and the Department of Public Health at Inje University Graduate School recently published a study titled “Multilevel Analysis of Factors Affecting Inter-hospital Transfer for Critically Ill Pediatric Patients” in the Korean Journal of Pediatric Emergency Medicine.

“Unnecessary transfers result in waste of medical resources, overcrowding of emergency departments, and rising medical costs,” the researchers said. “Appropriate institutional selection, rapid transfer, and specialized medical resources are necessary to prevent unnecessary transfers of critically ill pediatric patients.”

Using data from the 2021 Korean National Emergency Care Information Network, the researchers identified personal variables, including gender, severity of illness, and day of visit, and institutional variables, such as the rate of acceptance of patients by emergency department specialists and the rate of referrals to other departments, which influenced the number of pediatric patients with severe medical conditions who visited emergency departments.

Of the 956,616 pediatric patients with critical illness who visited ERs at community health centers or higher in 2021, 26,206 were selected for analysis after excluding patients who did not meet inclusion criteria.

Of these, 712 patients were transferred and 25,494 patients were not.

The analysis found that institutional variables, such as acceptance rate and total number of ER beds, influenced the number of transfers for severely ill pediatric patients. Individual variables included mode of transportation, time of visit, and type of injury.

For every 1 percent increase in receptive care coverage, the transfer odds decreased by 8 percent. For every additional ER bed, the transfer odds also increased by 2 percent.

Among personal variables, self-transport and other ambulances reduced the transfer rate by 51 percent and 60 percent compared to fire ambulances. ER visits between 6 p.m. and 7:59 a.m. the next day also reduced the transfer rate by 26 percent compared to daytime visits. The odds for transfer were 145 percent for severely injured patients, and the rate was higher among those who were unconscious at the time of the arrival than among those who were conscious.

The researchers also attributed the results to inaccuracies in the selection of emergency departments and the range of specialties involved.

“The higher the number of emergency room beds, the higher the probability of transfers. Beds are the main resource of emergency rooms and are also related to overcrowding and patient acceptance,” the researchers said. “Even in hospitals with the same level of emergency medical services, the utilization rate of emergency rooms in tertiary hospitals is higher than in general hospitals. The number of beds is important, but the range of specialties and treatment capabilities are crucial.”

The researchers said the probability of transfers increased for fire ambulance use, decreased consciousness at the time of visit, and severe injuries, which may be due to the higher severity of patients using ambulances. Other causes of transfer for severely ill patients included lack of capacity and inaccurate hospital selection, which leads to unnecessary transfers.

They called for a system to reduce unnecessary transfers for pediatric patients and increase emergency room resources.

The researchers also stressed that selection and concentration are needed to reduce unnecessary transfers and ensure stability.

“Hospitals may need to expand pediatric emergency medical centers, but it could be difficult to do so due to resource limitations,” they said. “The government’s support is needed by, for instance, regionalizing resources and selecting responsible pediatric medical institutions.”

The researchers added that a separate pediatric hospital transfer system should be established, considering children's unique characteristics.