351 - Patterns of Admission Leading to Interfacility Transfers in Pediatric Care

Publication Number: 4344.351

Sriamsha R. Dubbaka, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Sriram Ramgopal, Ann & Robert H. Lurie Children's Hospital of Chicago, CHICAGO, IL, United States; Kenneth Michelson, Lurie Children's Hospital, Chicago, IL, United States

Background: Acute care in pediatrics has become increasingly regionalized to specialized centers. This may impact the use of interfacility transfers within systems to meet the needs for pediatric patients needing admission.

Objective: To evaluate the characteristics and longitudinal trends of children admitted to the hospital following transfer from another acute facility ("transferred-in" status) in the United States.

Design/Methods: We performed a cross-sectional study using the 2009, 2012, 2016, 2019 and 2022 KIDS Inpatient Database, the largest publicly available US pediatric inpatient database. We described trends in transferred-in admissions overall and stratified by hospital type, age, medical complexity, and diagnosis. We evaluated inflation-adjusted costs associated with transferred-in admissions.

Results: We included 8,651,573 weighted non-live birth admissions over 5 study years, of which 1,210,430 (14.0% of all admissions, 95% confidence interval [CI] 13.5%-14.4%) were transferred-in. The percentage of transferred-in admissions increased from 8.9% in 2009 to 19.7% in 2022 (0.87 percentage points/year, 95% CI 0.73-1.02%). The most common diagnoses for transferred-in admissions were mood disorders (6.2%), acute bronchiolitis (4.9%), asthma (4.4%) and pneumonia (4.1%). All hospital types demonstrated an increase over time in transferred-in admissions, with urban non-teaching hospitals (0.91% per year, 95% CI 0.55%-1.26%) showing a larger increase than rural hospitals (0.55% /year, 95% CI 0.44%-0.66%; Figure 1). Children without medical complexity had steeper increases in transferred-in admissions compared to those with medical complexity (1.02%/year, 95% CI 0.85%, 1.19% vs 0.54%/year, 95% CI 0.44%-0.64%). Children aged 1-4 years had a greater rise in transfer-in admission over time than other age groups. By diagnosis, the greatest rises in transferred-in admissions were for suicide and self-inflected injury, bipolar disorder, and diabetic ketoacidosis (Figure 2). Costs for transferred-in patients, as a percentage of total pediatric admission costs, increased from 17.6% in 2009 to 30.3% in 2022 (+1.00 percentage points/year, 95% CI 0.7%-1.2%; Figure 3).

Conclusion(s): Despite declining overall admissions, pediatric transferred-in rates are rising as a proportion of admissions and account for increasing cost percentages. These findings may reflect reduced acute pediatric care capacity in some hospitals, creating vulnerability during surges. Further research should evaluate systemic strain in hospitals related to hospitalization of children.

Figure 1
Transported Patients Stratified by hospital type, age and medical complexity

Figure 2
Transferred-in admission patients stratified by diagnosis

Figure 3
Inflation adjusted cost estimate for transfer-in admission patients