A growing number of children who show up in US emergency rooms can’t get the treatment they need at their local hospital and need to be transferred elsewhere for care, a new study suggests.
Overall, in California, Florida, Massachusetts and New York – four of the most populous US states – pediatric transfers surged 25 percent: from roughly 64,000 in 2006 to close to 80,000 in 2011, researchers report in Pediatrics.
The biggest increase in transfers was for kids with common health problems like abdominal pain and asthma, offering fresh evidence that even basic pediatric care is disappearing from community hospitals, said senior study author Dr Michael McManus of Boston Children’s Hospital and Harvard Medical School.
‘When kids are taken to their local hospital’s emergency department, they are increasingly likely to be transferred to more distant referral centers for care they used to be able to get at home,’ McManus said by email. ‘We now know that pretty much the same thing is happening across the country.’
Pediatric transfers have become 25 percent more common in the US, meaning that families are more likely to have to travel to a second hospital when their children get sick or hurt
The researchers examined data on more than 252 million hospital encounters for children and adults, including about 59 million that resulted in admissions.
During the study, adult admissions remained constant at more than 7.1 million a year.
But the annual number of pediatric admissions declined 9.3 percent from more than 545,000 in 2006 to slightly under 495,000 in 2011.
The range of conditions treated, also known as pediatric capacity, declined at hospitals in all four states.
Over the course of the study, capacity declined an average of 13 percent in California, 24 percent in Florida, 27 percent in New York and 25 percent in Massachusetts.
Across all four states, the ten conditions that had the biggest average reductions in availability of pediatric care at local hospitals included appendicitis, skin infections, asthma, broken legs and tonsillitis.
The study wasn’t a controlled experiment designed to prove whether or how transferring children from one hospital to another might impact the quality of their care. It’s possible that transfer might improve outcomes for some conditions and worsen outcomes for others, the study authors note.
‘We know that patients want to be treated close to home if possible, but children are not just little adults,’ said Dr Fizan Abdullah, a researcher at the Ann and Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine.
‘They have special needs that can often best be treated by a pediatric specialist,’ Abdullah said by email.
Those specialists tend to be located where other pediatric services are located, for instance in a facility that has a pediatric anesthesiologist who is trained in the nuances of working with children, Abdullah added. That’s why pediatric specialists tend to gravitate toward children’s hospitals that have extensive resources specifically for kids.
For care closer to home, telemedicine and second opinion consults are often options, connecting hospitals that are sometimes closer to home with a regional center, Abdullah said. Parents can also look for satellite outpatient centers that are affiliated with a hospital with pediatric specialists.
‘The objective is to treat the child in the best way possible, with the most expertise, and get them home as soon as possible,’ Abdullah said. ‘Physicians at the referring hospital, or children’s hospital, can then also continue to work with their local provider as needed.’
When families have a choice of health insurance, they should also make sure those hospitals caring for their kids are in their insurance network, McManus advised.
‘For families taking sick kids to their local hospital, they should not be surprised if transfer is necessary to get the best care even for common conditions,’ McManus said.