Sanjiv Mehta, MD
Pediatric Critical Care Fellow
The Children's Hospital of Philadelphia
Philadelphia
Disclosure information not submitted.
Meghan Galligan, MD, MSHP
Attending Physician General Pediatrics, Assistant Professor of Pediatrics
The Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
George Haines, MBA
Financial Data Analyst - Principal
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Meaghan Lutts, MBA
Sr. Director Financial Planning & Analytics
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Christopher Bonafide, MD, MS
Research Director for Pediatric Hospital Medicine, Director, Patient Safety Learning Laboratory
The Children's Hospital of Philadelphia, United States
Disclosure information not submitted.
Robert Sutton, MD, FCCM
Professor of Anesthesia, Critical Care, & Pediatrics
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Title: Emergency Transfers Are Associated With Increased Financial Costs in Hospitalized Children
Introduction: A marker of late recognition, emergency transfers (ETx) are in-hospital deterioration events occurring outside the intensive care unit (ICU) that require intubation, vasopressor initiation, or ≥ 3 fluid boluses within 1 hour of transfer. Children with ETx have increased risk of mortality and length of stay. However, the financial impact of these deterioration events has not been previously described. The objective of this study was to evaluate the financial costs of ETx events in a single institution. We hypothesized that ETx would be associated with increased cost compared to non-ETx.
Methods: A single center retrospective cohort study of index transfers to the pediatric ICU at the Children’s Hospital of Philadelphia from January 2015 through June 2019. Primary exposure was ETx classification using EHR (Epic) data. Daily charges for each encounter were aggregated and adjusted for yearly inflation to fiscal year 2020 dollars. Charges were converted to costs based on institution specific cost-to-charge ratio. We compared ICU and post-transfer costs of care between patients with and without ETx using generalized linear models (gamma distribution, log link). A priori confounders were age, gender, prior service, transfer quarter, and presence of complex chronic condition.
Results: Among 2065 index transfers that occurred during the study period, 130 (6.3%) were classified as ETx; mortality: 101/2065 (4.9%). Financial data was available for 2063 (99.9%) of unplanned transfers. In univariable analysis, ICU costs (107% higher; 95% CI 50% to 185%; p< 0.01) and post-transfer costs (77% higher; 95% CI 32% to 135%; p< 0.01) were significantly higher in ETx vs. non-ETx. After adjustment for confounders, ICU costs (64% higher; 95% CI 25% to 116%; p< 0.01) and post-transfer costs (43% higher; 95% CI 9% to 89%; p=0.01) remained significantly higher in ETx vs non-ETx.
Conclusion: Patients with clinical deterioration outside the ICU meeting ETx criteria have increased ICU and post-transfer costs compared to non-ETx. Potential cost savings by reducing these events could justify investments in personnel and additional pro-active rapid response systems infrastructure.