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 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.
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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: https://bit.ly/2PZ43hc Pediatrics, online December 27, 2019.
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