Interfacility Transfers: A Process Ridden With Improvement Opportunities

Most pediatric emergency department visits occur in hospitals that see <15 children per day¹ and have insufficient pediatric resources.² As a result, nearly 350 000 children are transferred from hospital to hospital each year, and this number has increased over time.³ Unfortunately, the process of transferring patients between hospitals is fraught with communication breakdowns, diagnosis discordance, and delays in care.^4,5 Handoffs during transitions of care are the leading cause of serious medical errors,⁶ and interfacility transfers inherently impose heightened risk by involving handoffs across different hospitals. Moreover, transfers impose additional direct (eg, transport accidents) and indirect (eg, psychological distress, unwarranted testing) risk to patients.

Among the population of transferred pediatric patients, children with ≥1 complex chronic condition (CCC) are a particularly vulnerable population at risk for harm. Their complex medical needs often necessitate complex interventions that pretransfer emergency departments might not be prepared to manage. The patient care handoff during the transfer also likely involves more complex information relative to handoffs of children without a CCC. Furthermore, children with a CCC have an increased likelihood of transfer relative to their nonmedically complex counterparts.⁷ Despite prioritized efforts to improve care for children with CCCs, we lack research focused on improving care for these children during the transfer process.

In this issue of Hospital Pediatrics, White et al⁸ begin to address this important literature gap. They used the 2012 Healthcare Cost and Utilization Project Kids’ Inpatient Database (KID) to conduct a cross-sectional analysis of pediatric hospitalizations to describe the characteristics …