By Lisa Rapaport

(Reuters Health) – Hospitals are transferring more and more seriously ill and injured kids to other facilities instead of admitting them, a U.S. study suggests.

Researchers examined data representing 205 million emergency room visits by kids under 15 at 3,020 hospitals nationwide between 2008 and 2016. At the start of the study, 6% of children who were too seriously ill or injured to be discharged from the emergency room were admitted to the hospital where they initially arrived for care; by the end, only 2% of these kids were admitted.

“If you have a sick child who needs to stay in the hospital, your local hospital is less likely to provide everything you need, and you are more likely to get transferred elsewhere, possibly far from home,” said lead study author Dr. Kenneth Michelson of Harvard Medical School and Boston Children’s Hospital.

The emergency room is often the first place seriously ill and injured kids turn up for care, but many hospitals don’t have the specialists or equipment to care for them, particularly if they see few pediatric cases, Michelson and colleagues write in Pediatrics.

National efforts to improve access to acute care for kids have largely focused on improving the availability of resources in the emergency room, the study team notes. But still, hospitals’ ability to provide comprehensive emergency and acute care to kids has declined in several states including California, Florida, Massachusetts and New York.

For the current analysis, researchers focused on what’s known as the hospital capability index (HCI), which measures the degree to which a hospital provides inpatient care for patients who aren’t discharged from the emergency room and how often the hospital instead transfers patients to another facility for care. HCI scores range from 0 for hospitals that transfer every ER patient who isn’t discharged to 1 for hospitals that admit every patient who can’t be sent home.

Across all hospitals, the HCI score dropped from 0.06 in 2008 to 0.02 by 2016, the study found.

The HCI score didn’t change at all at children’s hospitals and facilities with dedicated pediatric care centers. But the HCI score fell everywhere else, declining the most at non-pediatric hospitals that saw the highest volume of children.

During the study period, total pediatric emergency room visits rose from 21.8 million annually to 24.1 million, but this difference wasn’t statistically meaningful. Over this same period, the proportion of kids transferred from the emergency room to a different hospital climbed by almost 28%, from about 234,000 to roughly 299,000.

Limitations of the study include the relatively small number of dedicated pediatric hospital centers in the U.S., which may make estimates of their capacity to treat kids and their transfer rates less accurate, the study team notes.

Even so, the results suggest that parents should ask a lot of questions when they bring a child to the emergency room, including whether their child might need specialists who are only available at other facilities, and whether they should consider someplace other than their local emergency room, Michelson advised.

“I strongly believe that children with an emergency should go to their local hospital, where a clinician can work with the family to decide what resources are needed,” Michelson said by email.

“In about 95% of cases, children can be discharged from the ER,” Michelson added. “In the other 5%, it’s often important to get care started soon.”

SOURCE: Pediatrics, online December 27, 2019.