Easing the strain on a pediatric tertiary care center - Use of a redistribution system

Objective: To evaluate the ability of a regionalized system to safely transfer patients requiring admission from a referral center to either regional or community hospitals. Design: Cohort study of children requiring admission. Following transfer, a questionnaire was administered to eligible caregivers. Subsequent emergency department ( ED) use was assessed by comparing children who were transferred with those who were not. Setting: The Hospital for Sick Children, Toronto, Ontario, Canada, from April 1, 2003, through March 31, 2004. Participants: Caregivers of 371 children who underwent transfer from a tertiary care center ED to either a regional or a community hospital were eligible; 344 were contacted. Two hundred fifty-three children for whom transfer was considered but was not performed served as a comparison group. Intervention: Questionnaire administered to caregivers, combined with database review. Main Outcome Measures: Failure of the transfer process, caregiver satisfaction, and future tertiary care center ED use. Results: Five children experienced intravenous access problems, and 4 children experienced delayed antibiotic administration. Caregiver satisfaction was 92.3% with the transfer process and 84.4% with the care at the receiving hospital. Forty-seven percent of caregivers indicated that they would agree to a similar transfer in the future. Two years later, fewer transferred children ( 39.9%) than those who were not transferred ( 49.6%) had revisited the tertiary care center ED ( odds ratio, 1.52; 95% confidence interval, 1.10-2.10). The mean number of visits was unchanged ( 95% confidence interval of the difference, -0.44 to 0.21 visits). Conclusions: Although we found the redistribution program to be safe, caregivers stated a preference not to be transferred again. The redistribution system did not substantially alter tertiary care center ED use.