Of the 27 million trips children make to U.S. emergency departments each year, about 7 million are at a rural ED or one that’s a considerable distance from a dedicated children’s hospital. For children critically ill with certain problems, of course, prompt transfer to a pediatric intensive care until improves the chances for positive outcomes.
In recent years, according to Christopher Johnson, a pediatric intensive care physician writing on KevinMd.com, the medical establishment has begun to establish a system of transporting these sick kids to regional critical care centers. That’s good. Not so good, Johnson says, is an increasing tendency to routinely transfer children from an ED not dedicated to pediatric care to one that is. Such transfers aren’t always necessary from a medical point of view, and present unnecessary risks and costs.
This kid shuffle, Johnson warns, might be signaling an unwillingness of general purpose EDs to provide basic pediatric care. That’s unacceptable. Misfortune is an equal age-opportunity reality.
Johnson refers to a recent article published in the journal Pediatrics that studied what happened to children after they arrived at an emergency department. Researchers wanted to know how ED resources were being used in the younger demographic.
Of the children transferred from the facility where they presented to another that provided specialized care, nearly 1 in 4 was discharged directly from that ED, and 17 in 100 were admitted to the hospital for less than 24 hours.
Because a significant number of the transferred kids had been discharged to go home, they probably could have been treated appropriately at the ED that sent them someplace else.
Johnson says you shouldn’t overlook the fact that sometimes a pediatric subspecialist at the second facility (say, a pediatric cardiologist), simply has the expertise to make the call for discharge that a less qualified doctor doesn’t.
But, he adds, “I have certainly seen children flown in by helicopter from another hospital and then get sent home. They didn’t need the expensive (and sometimes dangerous) helicopter ride.”
Johnson suggests that continuing to regionalize pediatric care is important in addressing the potential patient harm of such resource abuse. Regionalizing, he says, enables doctors in nonpediatric EDs to have easy access to specialists by phone or telemedicine links for remote consultation. This happens now, but only informally; codifying the process would improve care.
Medical emergencies are difficult enough without having to wonder if the care you get is sufficient or the advice to transfer is sound. But if you find yourself in a situation in which the emergency department wants to send your child to a facility that specializes in pediatric care, ask why. Find out what the doctors suspect is the problem and why they are unable to treat it. Ask about the availability of a remote consultation with a specialist.
Sometimes, that’s not possible and sometimes a transfer is the best medicine. But if it’s not, there’s no reason to assume unnecessary risk or cost.
To learn more about emergency medicine—what requires immediate, critical attention—see our backgrounder.