Urban and Rural Patterns in Emergent Pediatric Transfer: A Call for Regionalization. Issue 3 (25th October 2013)

• Record Type: Journal Article
• Authors: Horeczko, Timothy; Marcin, James P.; Kahn, Jeremy M.; Sapien, Robert E.; on behalf of the Consortium Of Regionalization Efforts in Emergency Medical Services for Children (CORE‐EMSC)
• Is Part Of: Journal of rural health. Volume 30:Issue 3(2014:Summer)
• Page Start: 252
• Page End: 258
• Publication Date: 2013-10-25
• Subjects: Rural health -- Periodicals; Rural health -- United States -- Periodicals; Medicine, Rural -- Periodicals; Medicine, Rural -- United States -- Periodicals; 362.104257
• DOI: 10.1111/jrh.12051
• Languages: English
• ISSNs: 0890-765X

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="jrh12051-sec-0010" sec-type="section"> <title>Context</title> <p>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.</p> </sec> <sec id="jrh12051-sec-0020" sec-type="section"> <title>Purpose</title> <p>To determine the epidemiology of pediatric transfers from urban and rural emergency departments (EDs).</p> </sec> <sec id="jrh12051-sec-0030" sec-type="section"> <title>Methods</title> <p>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.</p> </sec> <sec id="jrh12051-sec-0040" sec-type="section"> <title>Findings</title> <p>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, <italic>P</italic> < .01). Children from rural EDs were more than twice as likely to be transferred for a psychiatric indication (43.5% vs 19.5%, <italic>P</italic> < .01).</p> </sec> <sec id="jrh12051-sec-0050" sec-type="section"> <title>Conclusions</title> <p>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.</p> </sec> </abstract>