(100) Characteristics of Patients Requiring Transfer From a Tertiary-Care PICU to a Quaternary-Care PICU

Introduction: At its simplest, a Quaternary Pediatric Intensive Care Unit (PICU) can be defined as an extension of a Tertiary Care Center. Quaternary PICUs have access to the most advanced technological breakthroughs in the treatment of complex medical issues. They often conduct experimental therapies and provide services not available at Tertiary Care Centers. The objective of this review is to identify the reasons that admitted patients at a Tertiary Care PICU required transfer to a Quaternary PICU for Higher Level of Care.

Methods: A retrospective review of the Electronic Medical Record (EMR) of all PICU discharges was queried for all outgoing transports from January 2013 to December 2022. Transports were identified as going to a Higher Level of Care or Chronic Care Facility. Transfer Diagnosis, Indication for Transfer, Emergent versus Elective transfer, length of stay prior to transfer, and characteristics of referral hospital, including location, were noted.

Results: There were a total of 10,982 admissions (1,098 per year) with 90 transfers to Higher Level of Care Centers (0.8% of admissions). 28 of the transfers were considered for Emergent, Life-Threatening conditions and 62 were considered Elective transfers. Reasons for Transfer included Family requests (16), Consulting service request (27), Patient Followed at referring hospital (12), and Unavailable Services (24). There were 15 ECMO referrals (Cardiac, 8; Respiratory, 7), 10 Transplant referrals (Heart, 4; Lungs, 4; Liver 2), 3 Burn Unit transfers, 3 for Metabolic Evaluation, and 3 for Clinical Trials. Referrals were made to 9 different centers based on required expertise and insurance approval. Two centers accounted for 81% of referrals (73/90).

Conclusions: Transfers to Quaternary Care Centers should primarily be for Higher Level of Care or for services not available at the referring facility. Unfortunately, many non-clinical factors tended to dominate including Family requests, regional center requests, and Consulting service comfort level. None of the Quaternary Centers used were able to provide the full range of service required by our patients, thus requiring association with multiple centers.