title: Consideration of Cost of Care in Pediatric Emergency Transfer-An Opportunity for Improvement.
abstract: BACKGROUND
  Pediatric interhospital transfers are an economic burden to the health care, especially when deemed unnecessary. Physicians may be unaware of the cost implications of pediatric emergency transfers. A cost analysis may be relevant to reduce cost.
  
  
  OBJECTIVE
  To characterize children transferred from outlying emergency departments (EDs) to pediatric ED (PED) with a specific focus on transfers who were discharged home in 12 hours or less after transfer without intervention in PED and analyze charges associated with them.
  
  
  METHODS
  Charts of 352 patients (age, 0-18 years) transferred from 31 outlying EDs to PED during July 2009 to June 2010 were reviewed. Data were collected on the range, unit charge and volume of services provided in PED, length of stay, and final disposition. The average charge per patient transfer is calculated based on unit charge times total service units per 1000 patients per year and divided by 1000. Hospital charges were divided into fixed and variable.
  
  
  RESULTS
  Of 352 patients transferred, 108 (30.7%) were admitted to pediatric inpatient service, 42 (11.9%) to intensive care; 36 (10.2%) went to the operating room, and 166 (47.2%) were discharged home. The average hospital charge per transfer was US $4843. Most (89%) of the charges were fixed, and 11% were variable. One hundred one (28.7%) patients were discharged home from PED in 12 hours or less without intervention. The hospital charges for these transfers were US $489,143.
  
  
  CONCLUSIONS
  Significant number of transfers was discharged 12 hours or less without any additional intervention in PED. Fixed charges contribute to majority of total charges. Cost saving can be achieved by preventing unnecessary transfer.
authors.affiliation: From the Division of Pediatric Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Rajender K
authors.initials: RK
authors.lastname: Gattu
authors.forename: Ann-Sophie
authors.initials: AS
authors.lastname: De Fee
authors.forename: Richard
authors.initials: R
authors.lastname: Lichenstein
authors.forename: Getachew
authors.initials: G
authors.lastname: Teshome
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000191:economics* / Q000592:standards; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D017722:Hospital Charges / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000639:trends; D008297:Male; D010351:Patient Discharge / Q000191:economics / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000191:economics* / Q000706:statistics & numerical data; D000070316:Pediatric Emergency Medicine; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology