O3215: Pediatric Interfacility Transfer Requests, Denials, and Implications at a Regional Children’s Hospital

Background: The closure of pediatric inpatient units in community and rural hospitals has disproportionately affected under resourced communities, resulting in increased referrals and transfers of children to larger, regional children’s hospitals. The “triple-demic” of influenza, RSV, and COVID-19 in 2022 further exacerbated these issues, increasing dependence on regional children’s hospitals, increasing transfer requests and denials, and delaying access to appropriate levels of care. The aim of this study was to examine interfacility medical consultation requests for pediatric services, interfacility transfer requests, and transfer denials at a large, academic, regional children’s hospital and report changes in the children’s hospital’s utilization of inpatient telehealth to provide support to referring centers.

Methods: This is a retrospective study of incoming calls from July 2019 to December 2023 to the University of California (UC) Davis Children’s Hospital transfer center from outside emergency departments for pediatric specialist consultations and transfer requests. Telehealth consultations were conducted by telephone and/or video.. Transfer request denials included those requests for a children’s hospital bed in the PICU, NICU and Pediatric Ward. Calls requesting assistance for pediatric subspecialties were included to assess the change in responses (transfer acceptance/denial, consultation/support) starting prior to the COVID-19 pandemic.

Results: Transfer requests to the PICU, NICU, and Pediatric Ward averaged 279 per month during the 42-month study period. Accepted transfers averaged 211 per month, and transfer denials due to bed and/or staffing shortages averaged 38/month. The mean number of telephone and telemedicine consultations were 27/month and 3.3/month, respectively. Figure 1 demonstrates the spikes in transfer requests as high as 640/month (a 203% increase over the mean) and transfer denials due to bed and/or staffing shortages as high as 375/month (58.6% of transfer requests) during the triple-demic in November 2022. Of note, the number of patient transfers accepted to the Children’s hospital remained stable during surges, including the triple-demic (Figure 1). The number of consultations (Figure 2), both telephone and telemedicine, has been steadily increasing following the triple-demic without associated increases in transfer requests.

Conclusion: Our data demonstrate an inability for a large academic regional children’s hospital to effectively handle surges in transfer requests, most exemplified by the triple-demic in 2020. Transfer acceptance numbers remain constant with denials due to bed and staffing capacity spiking during surges, the later having deleterious effects on patients, families, and clinical outcomes. As pediatric beds continue to close , pediatric specialists are providing an increasing number of telephone and telemedicine consultations, particularly during surges. The frequency of consultations is continuing to rise even after surges in consultation requests following the triple-demic. The Western Regional Alliance for Pediatric Emergency Management (WRAP-EM) continues to document issues related to emergency management and is continuing to propose solutions at a regional and national level.