Emergency Department Pediatric Readiness and Potentially Avoidable Transfers - PubMed (original) (raw)

Observational Study

Emergency Department Pediatric Readiness and Potentially Avoidable Transfers

Monica K Lieng et al. J Pediatr. 2021 Sep.

Abstract

Objective: To determine the association between potentially avoidable transfers (PATs) and emergency department (ED) pediatric readiness scores and the score's associated components.

Study design: This cross-sectional study linked the 2012 National Pediatric Readiness Project assessment with individual encounter data from California's statewide ED and inpatient databases during the years 2011-2013. A probabilistic linkage, followed by deterministic heuristics, linked pretransfer, and post-transfer encounters. Applying previously published definitions, a transferred child was considered a PAT if they were discharged within 1 day from the ED or inpatient care and had no specialized procedures. Analyses were stratified by injured and noninjured children. We compared PATs with necessary transfers using mixed-effects logistic regression models with random intercepts for hospital and adjustment for patient and hospital covariates.

Results: After linkage, there were 6765 injured children (27% PATs) and 18 836 noninjured children (14% PATs) who presented to 283 hospitals. In unadjusted analyses, a 10-point increase in pediatric readiness was associated with lower odds of PATs in both injured (OR 0.93, 95% CI 0.90-0.96) and noninjured children (OR 0.90, 95% CI 0.88-0.93). In adjusted analyses, a similar association was detected in injured patients (aOR 0.92, 95% CI 0.86-0.98) and was not detected in noninjured patients (aOR 0.94, 95% CI 0.88-1.00). Components associated with decreased PATs included having a nurse pediatric emergency care coordinator and a quality improvement plan.

Conclusions: Hospital ED pediatric readiness is associated with lower odds of a PAT. Certain pediatric readiness components are modifiable risk factors that EDs could target to reduce PATs.

Keywords: emergency medical services [MeSH]; facilities and services utilization [MeSH]; health care transition [MeSH]; patient transfer [MeSH]; quality of health care [MeSH]; transfer agreement [MeSH].

Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

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Conflict of interest statement

Conflicts of Interest

The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.

Figure 1.

Linkage strategy and study population

Figure 2.

Figure 2.

Definition of potentially avoidable transfers

Figure 3.

Figure 3.

Directed acyclic graph using DAGitty v3.0

Figure 4.

Figure 4.

Distributions of pediatric readiness scores with proportional potentially avoidable transfers (PATs). A, All hospitals (_N_=283). B, Injured study population (_N=_269). C, Non-injured study population (_N=_275)

References

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