All authors: Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Crit Care Explor. 2024 Oct 25;6(11):e1175. doi: 10.1097/CCE.0000000000001175. eCollection 2024 Nov 1.
The U.S. pediatric acute care system has become more centralized, placing increasing importance on interhospital transfers.
We conducted a geospatial analysis of critically ill children undergoing interfacility transfer with a specific focus on understanding travel distances between the patient's residence and the hospitals in which they receive care.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective geospatial analysis using five U.S. state-level administrative databases; four states observed from 2016 to 2019 and one state from 2018 to 2019. Participants included 10,665 children who experienced 11,713 episodes of critical illness involving transfer between two hospitals.
Travel distances and the incidence of "potentially suboptimal triage," in which patients were transferred to a second hospital less than five miles further from their residence than the first hospital.
Patients typically present to hospitals near their residence (median distance from residence to first hospital, 4.2 miles; interquartile range [IQR], 1.8-9.6 miles). Transfer distances are relatively large (median distance between hospitals, 28.9 miles; IQR, 11.2-53.2 miles), taking patients relatively far away from their residences (median distance from residence to second hospital, 30.1 miles; IQR, 12.2-54.9 miles). Potentially suboptimal triage was frequent: 24.2 percent of patients were transferred to a hospital less than five miles further away from their residence than the first hospital. Potentially suboptimal triage was most common in children living in urban counties, and became less common with increasing medical complexity.
The current pediatric critical care system is organized in a hub-and-spoke model, which requires large travel distances for some patients. Some transfers might be prevented by more efficient prehospital triage. Current transfer patterns suggest the choice of initial hospital is influenced by geography as well as by attempts to match hospital resources with perceived patient needs.
美国儿科急症护理系统变得更加集中，使得医院间转院的重要性日益增加。
我们进行了一项批判性儿童接受医院间转院的地理空间分析，特别关注了解患者居住地和接受治疗的医院之间的旅行距离。
设计、地点和参与者：使用五个美国州级行政数据库进行回顾性地理空间分析；四个州观察了 2016 年至 2019 年的数据，一个州观察了 2018 年至 2019 年的数据。参与者包括 10665 名经历了 11713 次严重疾病转院的儿童。
旅行距离和“潜在次优分诊”的发生率，其中患者被转往第二家医院，距离他们的住所比第一家医院近不到五英里。
患者通常在离家较近的医院就诊（距第一家医院的距离中位数为 4.2 英里；四分位距[IQR]为 1.8-9.6 英里）。转院距离相对较大（医院之间的距离中位数为 28.9 英里；IQR 为 11.2-53.2 英里），使患者远离他们的住所（距第二家医院的距离中位数为 30.1 英里；IQR 为 12.2-54.9 英里）。潜在次优分诊很常见：24.2%的患者被转往离家比第一家医院近不到五英里的医院。潜在次优分诊在城市县的儿童中更为常见，随着医疗复杂性的增加，这种情况变得越来越少见。
当前的儿科重症护理系统以枢纽和辐条模式组织，这需要一些患者进行长途旅行。通过更有效的院前分诊，一些转院可能会被预防。当前的转院模式表明，初始医院的选择不仅受到地理因素的影响，还受到试图根据患者需求匹配医院资源的影响。
