(313) Travel Distances for Interhospital Transfers of Critically Ill Children: A Geospatial Analysis

Introduction: Recent closures of community inpatient pediatric units have resulted in a more centralized pediatric acute care system, emphasizing the need for efficient transfer of critically ill children to definitive sites of care. We aimed to understand current travel distances for inter-hospital transfers and the distances between the initial hospital and the definitive hospital relative to patients’ homes. We hypothesized that the travel distance to an initial hospital was commonly similar to the distance to a definitive hospital, indicating potential inefficiencies in the acute care transfer system.

Methods: We used the Health Care Utilization Project’s 2018 State Inpatient Database and State Emergency Department Database to study claims from Florida, Wisconsin, and Utah. We constructed episodes in which children received care in geographically distinct hospitals, and were ultimately admitted to an intensive care unit, excluding neonatal, maternal, and rehabilitation claims. We calculated geodesic distances from the population-weighted centroid of the patient’s home ZIP code to the first and second hospital in which the patient received care.

Results: There were 1,934 transfer episodes representing 1,832 unique patients. Median (interquartile range) distances from the patient’s home to the presenting hospital and home to the destination hospital were 4.7 (2.2-10.3) miles and 29.5 (12.9-50.4) miles, respectively, while the distance between these hospitals was 29.2 (12.2-48.1) miles. The definitive hospital was closer to the patient’s home than the initial hospital in 193 (10.0%) of episodes, less than 5 miles further away from the patient’s home in 426 (22.0%) episodes, and less than 10 miles further in 628 (32.5%) episodes. These patterns were more common for patients from metropolitan areas compared to those from micropolitan or rural areas.

Conclusions: Many critically ill children are transferred to hospitals that are not substantially farther from home than their presenting hospital, indicating possible inefficiencies in the current system. Efforts to optimize prehospital referral patterns could reduce the need for interhospital transfer while also getting children to definitive care more quickly, potentially improving pediatric critical care outcomes.