Comparison of critically ill and injured children transferred from referring hospitals versus in-house admissions.
OBJECTIVE
The purpose of this work was to compare the outcomes, severity of illness, and resource use of patients transferred to PICUs from outside hospitals to patients admitted from within the same hospital.


METHODS
We conducted a secondary analysis of patients from the 20 US PICUs in the most recent Pediatric Intensive Care Unit Evaluations Software Recalibration Database on a total of 13,017 emergent PICU admissions between January 2001 and January 2006. Dependent variables were PICU resource use and risk-adjusted mortality. The main independent variable was the PICU admission source: patients transferred from referring emergency departments and inpatient wards versus in-house admissions from the same hospitals' emergency departments and inpatient ward.


RESULTS
Patients admitted from referring emergency departments had higher use of vasoactive infusions (7.31% vs 5.23%) and mechanical ventilation (33.45% vs 23.6%) than same-hospital emergency department admissions. Compared with in-house ward admissions, patients transferred from referring inpatient wards had higher mechanical ventilation rates (45.05% vs 28.56%) and PICU lengths of stay (8.0 vs 6.7 days).


CONCLUSIONS
On average, children admitted to a cohort of US PICUs from referring hospitals were more ill and required more intensive care resources than patients admitted to the same PICUs from within the institution. Hospital-level differences in PICU efficiency and severity of illness were highly variable. These data highlight the need for standardized PICU admission criteria to maximize hospital efficiency and suggest opportunities for earlier intervention and consultation by hospitals with PICU-level services to improve quality of care for critically ill children.
Gregory
Christopher J
CJ
Department of Pediatrics, University of California Davis Children's Hospital, USA. christopher.gregory@ucdmc.ucdavis.edu
Nasrollahzadeh
Farid
F
Dharmar
Madan
M
Parsapour
Kourosh
K
Marcin
James P
JP
D002140:California; D002648:Child; D002673:Child, Hospitalized / Q000706:statistics & numerical data; D002675:Child, Preschool; D015331:Cohort Studies; D003422:Critical Care / Q000592:standards / Q000639:trends; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006757:Hospital Units; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D008297:Male; D010343:Patient Admission; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011336:Probability; D011787:Quality of Health Care; D012017:Referral and Consultation; D012042:Registries; D020379:Risk Adjustment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D014187:Transportation of Patients / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*