PM2050: Transfer Indications for Pediatric Gastroenterology Patients Admitted to a Regional Children’s Hospital

Background: Regional hospitals allow patients requiring inpatient pediatric specialty care to be admitted closer to home, with significant psychosocial benefits and lower transportation costs. Many of these sites have pediatric hospitalists with other specialties available on a consult basis, but they do not have all the services available at pediatric quaternary care centers. Therefore, the decision to admit higher acuity and/or complexity patients necessitates balancing the likelihood of subsequent clinical change that surpasses the site’s capabilities with the goal of maximizing local resource utilization. These decisions can be challenging because the transfer likelihood for specific pediatric patient populations at these sites is not well-described. We sought to understand the transfer rate and transfer indications for inpatients requiring gastroenterology (GI) consultation at a 115-bed regional children’s hospital with a pediatric hospital medicine group, PICU and level III NICU.

Methods: Retrospective chart review was performed on all hospital encounters with GI consults at the regional children’s hospital between July 1, 2020 and June 30, 2021, to identify those that included transfer to a quaternary care children’s hospital 60 miles away. Patients were admitted predominantly to hospital medicine, surgery or critical care services; there was no primary GI service. Encounters resulting in transfer were independently reviewed by a pediatric hospitalist and a pediatric gastroenterologist to evaluate the reason and necessity for transfer. Transfers out of the emergency department and admissions to the NICU were excluded.

Results: 302 hospital encounters, representing 248 unique patients (mean age: 7 years, range: 0-20 years), included GI consultation. Of these, 12 encounters (4%) resulted in transfer to the quaternary care center with no patients requiring transfer during more than one hospitalization. The median time from admission to transfer was 2.8 days (range: 0.8-14.1 days). Primary diagnoses (Figure 1) spanned a broad spectrum of acuity and complexity, and all transfers were necessary to access highly specialized clinical services not available locally (Table 1). There were no deaths after transfer or poor outcomes related to transport, and no deaths during hospitalization among patients who were not transferred.

Conclusion: Admitting pediatric patients needing GI specialty care to a regional hospital with a small GI group available for consultation successfully kept most patients close to their homes. There was a minimal subsequent transfer rate, only 1 transfer < 24 hours after admission and no adverse transfer-related outcomes, indicating that patient acceptance decisions by primary service physicians (mostly pediatric hospitalists) appropriately balanced health system resource utilization and patient safety. These data support management of most pediatric GI patients at regional hospitals with a GI consultation service but also underline the necessity for developing transfer processes and relationships with a quaternary care center. Further evaluation is needed to determine if similar results are seen for other specialties.