557 - Hit the Road, Kid: Trauma Transfers After Ward Closure

Publication Number: 1536.557

Jennifer Teng, Madigan Army Medical Center, DuPont, WA, United States; Zachary Riggenbach, Madigan Army Medical Center, Dupont, WA, United States; Brooklyn Williams, Madigan Army Medical Center, Lakewood, WA, United States; Kim M.. Royer, Providence Regional Medical Center, Everett, WA, Lake Stevens, WA, United States; Jacob J. Glaser, Madigan Army Medical Center, Mukilteo, WA, United States

Background: Pediatric inpatient units have declined by nearly 30% across the United States over the past decade. As a result, children presenting with traumatic injuries are increasingly transferred to tertiary centers for inpatient care. While often necessary, such transfers may introduce delays, duplicate services, and increase healthcare costs.

Objective: This study examines the effects of a pediatric ward closure on trauma transfer patterns, emergency department (ED) throughput, and system-level financial burden. By quantifying changes in patient flow and financial burden, we aim to highlight the broader consequences of pediatric inpatient unit closures within community hospitals.

Design/Methods: With IRB approval, we conducted a retrospective cohort study at a regional Level II trauma center. Pediatric trauma encounters were analyzed before (January 1, 2016-June 30, 2022) and after (July 1, 2022-December 30, 2024) the closure of the hospital's pediatric inpatient unit. Outcomes included transfer status, ED length of stay (LOS), Injury Severity Score (ISS), and mechanism of injury (MOI). Cost estimates included ambulance transport, ED LOS, and repeat care upon arrival at the receiving hospital. Statistical analyses included Chi-square, Fisher's exact test, Shapiro-Wilk, and Wilcoxon rank-sum tests with p < 0.05 considered significant.

Results: Following ward closure, pediatric transfers increased absolutely by 7.6% (p < 0.05), while ISS remained stable. ED LOS was 35 minutes longer for transferred patients and 20 minutes longer for all patients (p < 0.05). The proportion of transferred patients increased significantly following ward closure for two MOI (p < 0.05). Estimated per-patient transfer-related costs averaged approximately $9,250, including hospital charges, county-specific ambulance fees, and prolonged ED boarding, with total excess costs of about $431,700.

Conclusion(s): The closure of a pediatric ward at a regional trauma center resulted in increased pediatric transfers, longer ED wait times, and considerable system-wide costs. Although these transfers were medically appropriate, they introduced inefficiencies that duplicated care, strained resources, and delayed definitive trauma management.

In the context of ongoing pediatric hospital closures nationwide, these findings highlight the critical role of maintaining pediatric capacity at community hospitals. Preserving this infrastructure may not only reduce system-wide expenditures but also ensure that pediatric trauma patients receive timely, high-quality care closer to home.

Figure 1. Ratio of pediatric trauma patients transferred before and after pediatric ward closure.
The percentage of transferred patients increased from 30.4% in the pre-closure period to 38.0% post-closure, representing an absolute increase of 7.6% (χ² test, p < 0.05).

Figure 2. ED length of stay (LOS) before and after pediatric ward closure for all patients (dark gray) and transferred patients (light gray).
Median LOS rose from 189 to 209 min for all patients and from 191 to 226 min for transferred patients (Wilcoxon rank-sum, p < 0.05 for both).

Figure 3. Proportion of patients transferred for low-height falls ( <1 m) and knife injuries before and after pediatric ward closure.
Transfer proportions increased significantly for both mechanisms (p = 0.001 for falls <1 m; p = 0.026 for knife).