210 - Trends in Pediatric Emergency Department Transfers from Indian Health Service Hospitals

Poster Number: 210
Publication Number: 210.320

Fiona A. Pirrocco, Phoenix Children's Hospital, Phoenix, AZ, United States; Cherisse Mecham, Phoenix Children's Hospital, Phoenix, AZ, United States; Karen Yeager, Phoenix Children's Hospital, Phoenix, AZ, United States; Hamy Temkit, Phoenix Children's Hospital, Phoenix, AZ, United States

Background: Emergency department (ED) transfers to pediatric institutions have been increasing nationwide. Patients in rural communities are especially vulnerable to this trend and are now less likely to receive definitive care at their hospital of choice for even common conditions. Many Indian Health Service (IHS) EDs are located rurally, and transfer patterns and healthcare utilization for this population is currently unknown.

Objective: Describe the frequency of all transfers to a pediatric referral center from 2017-2020 and the final disposition, length of stay (LOS), and most common primary ICD-10 diagnoses for IHS ED transfers from 2017-2018.

Design/Methods: We performed a retrospective chart review of all patients transferred to a level 1 pediatric trauma center ED located in the southwest United States from 2017 to 2020 (Nf35,741). Patient data was obtained from the referral institution transfer call center. Data analysis excluded expected patient transfers that did not arrive to the referral hospital and expected patient transfers which were missing a medical record number.

Results: An average of 6.8% of all transfers were from IHS EDs between 2017-2020 (Table 1). 57% of patients (570/1004) who were transferred from IHS EDs in 2017 and 2018 were admitted to the referral hospital inpatient unit, intensive care unit, or a surgical specialty. 67% of admitted patients during this time had a LOS greater than 24 hours, with a significant increase in LOS from 2017 to 2018 (Table 2). The most common primary ICD-10 diagnoses for all patients transferred from IHS EDs in 2017 and 2018 included acute respiratory failure with hypoxia, abdominal pain, croup, asthma, and pneumonia (Table 3).Conclusion(s): Transfers from IHS EDs in this region have remained stable over a four-year period. Patients who are transferred from IHS EDs are often admitted and frequently experience a length of stay greater than 24 hours. Common diagnoses not typically requiring specialty care, such as croup and asthma, were among the most frequently transferred which supports prior studies regarding the regionalization of definitive care for common conditions. These outcomes highlight the health needs and utilization patterns among the IHS community which can be used to inform resource allocation and educational interventions. Further studies are needed to identify barriers to definitive care among IHS hospitals.

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