Could Teleconsultation Reduce Pediatric Transfers?

May 1, 2024

Written by Ketan Patel and Abigail Limov

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This retrospective study found that of the 4,446 patients transferred over a 4.5-year period, 1,509 (34%) transfers could have possibly been avoided by utilizing telehealth/teleconsultation, with the most common transfer complaints being abdominal pain, asthma, and cough. 

Burden, myth, or a real opportunity?
Numbers of pediatric patient transfers have been increasing, adding to the burden of already overcrowded pediatric emergency departments. This study took all transfers from one hospital system and split them into low resource intensity and high resource intensity visits and then reviewed and trended all the cases to determine if they could have avoided transfer by utilizing telehealth or teleconsultation services.

Almost 1 in 10 (9%) of the transfers met low-resource intensity per their review. Of the analyzed non-low-resource intensity cases, the biggest opportunities to mitigate transfers included the availability of specialty consultants and resources (imaging/labs). It is in this subset that the authors felt there could be a vital role of teleconsultation to mitigate these potential transfers.

A pitfall of this study is a potential overestimation of avoidable transfers, as actual transferring facility resources were not always known at the moment of transfer. In addition, given the dynamic nature of many illnesses, even teleconsultation cannot predict which transferred patients may markedly improve en route and need minimal resources upon arrival.

How will this change my practice?
Working at a tertiary care facility with a dedicated Pediatric ED, I appreciate that transfers lead to financial burden on families, overcrowding, and increased workload on staff that are already stretched. I see an opportunity for telehealth in mitigating transfers. Regional and local factors, however, including consultant and provider buy-in as well as the burden of cost and staffing, would need to be weighed against the impact within each regional hospital care system.

Editor’s note: I think the number of potentially preventable transfers may be much lower, maybe 5-10%. To categorize a transfer as preventable because all that was needed at the tertiary facility was a lab or imaging study is kind of like saying, “If we had ham we could have ham and eggs, if we had eggs.” Many times, the referring hospital doesn’t have the lab or imaging study needed to make the disposition decision, in which case, transfer is appropriate. Just a thought. ~Clay Smith

Source
Pediatric Patients Discharged After Transfer to a Pediatric Emergency Department: Opportunities for Telehealth?. Ann Emerg Med. 2024;83(3):208-213. doi:10.1016/j.annemergmed.2023.08.489