TOP 30 - Potentially avoidable transfers (PAT) of patients with languages other than English (LOE) from general emergency departments to a pediatric quaternary care facility

Publication Number: 4733.TOP 30

Carly G. Muller, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Christina Rojas, 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: Nearly 500,000 pediatric patients are transferred between emergency departments (EDs) in the United States annually. Prior studies demonstrate that the greatest burden of ED interfacility transfers is with children from low-income, rural, and resource-limited areas. Up to one-third of pediatric transfers to the pediatric ED result in discharge without specialty interventions or procedures, resulting in a potentially avoidable transfer (PAT.) These may occur more frequently among patients speaking a language other than English (LOE).

Objective: This study aims to (1) categorize factors associated with PATs of pediatric patients from general EDs to a pediatric quaternary care center and (2) evaluate the association of LOE and PAT.

Design/Methods: We are conducting a retrospective cohort study of children between 2016-2022 presenting to an urban, quaternary care pediatric emergency department (ED). We will use the PED Screen registry, an electronic health record registry developed for the Pediatric Emergency Care Applied Research Network, with IRB approval, We will exclude children arriving from short/long-term care facilities. We will obtain demographics, clinical measures, ED flow factors, disposition, procedures and sedations, and subspecialty consultation. We will categorize principal diagnoses using the Diagnosis and Grouping System. Medical complexity and illness severity will be accounted for using the Complex Chronic Condition algorithm and Emergency Severity Index. Based on prior literature, a PAT is defined as any ED discharge not requiring specialist consultation, procedures , surgery, or sedation. The exposure is binary LOE. The primary outcome variable is PAT. We will describe characteristics of the sample population, stratified by PAT. Logistic regression will be used to conduct univariable and multivariable odds ratios. Utilizing these criteria, a cohort of 10,873 encounters for children (0-17 years of age) transferred to the ED from another hospital was identified using patient arrival mode documentation.