title: Factors associated with emergency department discharge after pediatric interhospital transport: a role for outreach education?
abstract: OBJECTIVE
  To characterize the disposition of children transported from an outside emergency department (ED) to a children's hospital ED and examine associations between patient and referring ED factors with discharge from the receiving ED.
  
  
  METHODS
  We collected data from existing electronic data sources and telephone interviews of referring ED directors. We included all pediatric patients who were transported from an outside ED to the Children's National Medical Center ED between July 2009 and June 2010. We examined patient factors of age, diagnosis, and illness severity and referring ED factors of annual pediatric volume and staffing for associations with ED discharge.
  
  
  RESULTS
  Of 3288 transported patients, 2230 (68%) were admitted, 1025 (31%) were discharged, and less than 1% died. In univariate analyses, discharge from the receiving ED was associated with trauma diagnoses (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.7-2.4), transports from low pediatric volume EDs (OR, 2.0; 95% CI, 1.7-2.4), and from EDs without pediatric physician staffing (OR, 2.1; 95% CI, 1.8-2.6). In multivariate analyses, discharge was associated with trauma and gastrointestinal diagnoses (adjusted OR 1.6 [95% CI, 1.2-2.2] and 1.9 [95% CI, 1.4-2.6], respectively) as well as low referring ED pediatric volume and nonpediatric physician staffing (adjusted OR, 1.7 [95% CI, 1.4-2.1] and 1.9 [95% CI, 1.5-2.5], respectively) when controlling for all other factors.
  
  
  CONCLUSIONS
  In this single-site study, children referred from outside EDs with lower pediatric volumes and staffed by nonpediatricians were more likely to be discharged from a children's hospital ED after transport. These transports may represent unnecessary resource use. Outreach education, shared staffing models, and telemedicine are potential methods to address unnecessary transfers.
authors.affiliation: From the *Division of Emergency Medicine, Children's National Medical Center, Washington, DC; and †Division of Pediatric Emergency Medicine, The Johns Hopkins Hospital, Baltimore, MD.
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Walls
authors.forename: James M
authors.initials: JM
authors.lastname: Chamberlain
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Klein
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014187:Transportation of Patients / Q000706:statistics & numerical data*; D014218:Triage / Q000706:statistics & numerical data*; D055815:Young Adult