Emergency Transfers: An Important Predictor of Adverse Outcomes in Hospitalized Children
In-hospital arrests are uncommon in pediatrics, making it difficult to identify the risk factors for unrecognized deterioration and to determine the effectiveness of rapid response systems. An emergency transfer (ET) is a transfer from an acute care floor to an intensive care unit (ICU) where the patient received intubation, inotropes, or ≥3 fluid boluses in the first hour after arrival or before transfer. Improvement science work has reduced ETs, but ETs have not been validated against important health outcomes. This case–control study aimed to determine the predictive validity of an ET for outcomes in a free-standing children’s hospital. Controls were matched in terms of age, hospital unit, and time of year. Patients who experienced an ET had a significantly higher likelihood of in-hospital mortality (22% vs 9%), longer ICU length of stay (4.9 vs 2.2 days), and longer posttransfer length of stay (26.4 vs 14.7 days) compared with controls (P < .03 for each).
© 2019 Society of Hospital Medicine
CONCLUSION
Patients who experienced an ET had a significantly higher likelihood of in-hospital mortality, spent more time in the ICU, and had a longer hospital LOS posttransfer than matched controls. The use of the ET metric in children’s hospitals would allow for further analysis of such patients in hopes of identifying clinical characteristics that serve as predictors of deterioration. This may facilitate better risk stratification in the clinical system as well as enable more rapid learning and systems improvements targeted toward preventing unrecognized clinical deterioration.
Disclosures
Dr. Hussain, Dr. Sosa, Dr. Ambroggio, and Mrs. Gallagher have nothing to disclose. Patrick Brady reports grants from the Agency for Healthcare Research and Quality, outside the submitted work. The authors certify that this submission is not under review by any other publication. The author team has no conflicts of interest to disclose.
Funding
Ms. Hussain was supported by the Society of Hospital Medicine’s Student Hospitalist Scholar Grant Program in 2017. Dr. Brady receives career development support from AHRQ K08-HS023827. The project described was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health, under Award Number 5UL1TR001425-04. The content is solely the responsibility of the authors and does not necessarily represent the official views of the SHM, AHRQ, or NIH.
