Yutika Mandal, MD, MD
Resident
The Brooklyn Hospital Center
Brooklyn, NY
Disclosure information not submitted.
Melanie Watman, MD
PGY III
The Brooklyn Hospital Center, United States
Disclosure information not submitted.
Louisdon Pierre, MD, MBA,
Chief, Pediatric Critical Care, Director, Pediatric Inpatient Services
The Brooklyn Hospital Center
Suffern
Disclosure information not submitted.
Adebayo Adeyinka, MD, FCCM
Assistant Professor of Clinical Pediatrics
Icahn School of Medicine at Mount Sinai
Disclosure information not submitted.
Noah Kondamudi, MD, MBA. FACEP. FAAP. CPE
Chair Department of Pediatrics
The Brooklyn Hospital Center, United States
Disclosure information not submitted.
Title: Determinant Factors for Outbound Transfers in a Community Hospital Pediatric Intensive Care Unit
Introduction: Hospital transfers are an essential component of patient care in community hospitals. Among adult ICUs in the US, one in 20 are transferred to another hospital largely due to medical needs. A multicenter cohort study reported that 6.4% of adult ICU admissions came directly from other hospitals. Although undertaken to improve the quality of care, other factors may play a role. We were unable to identify the frequency and reasons for outbound transfers from a community hospital PICU setting. The objective of this study is to evaluate the frequency and reasons for transfer of pediatric patients from a community hospital PICU.
Methods: This is a retrospective analysis of all outbound transfers of pediatric patients from a community hospital PICU between 2010-2020. Patients transferred from our emergency department were excluded. The data collected included patient demographics (age, sex, race), admission diagnosis, length of PICU stay at our institution, and reasons for the transfer. Statistical analysis was performed using the Chi-square test to compare variables.
Results: A total of 87 transfers occurred during the study period out of 4719 admissions, for a transfer rate of 2%. The racial demographics were 45% African American, 24% Caucasian, 10% Hispanic, 6% Asian. The most frequent cause was the need for a ‘higher level of care' than could be provided at our institution in 61% (n=53). The need for alternate level of care (psychiatric, hospice, and chronic care facility) accounted for 26% (n= 23). Parental requests for transfer occurred only in 13% (n=11). Among those needing higher-level care, neuro-critical (26%) and cardiac care (26%) were most frequent. There was no significant association between, age, gender, or race with the reasons for transfer. There was a significant association with prolonged length of stay with transfer to an alternate level of care.
Conclusions: Outbound transfers occurred for 2% of admission at our community hospital PICU. The most common reason for transfers was the need to provide a higher level of care, most frequently neurocritical care. Parental requests for transfer were infrequent. Most patients admitted to community PICUs can be successfully managed locally, and outbound transfers are uncommon. It is prudent to maintain collaboration with a tertiary-level PICU