Impact of the "Triple-Demic" on Interfacility Transfers and Consultations: A Retrospective Study.

Abstract

Background: The erosion of pediatric care capability in community hospitals has heavily impacted rural communities, leading to more transfers to larger regional children's hospitals. The 2022 triple-demic of influenza, respiratory syncytial virus, and COVID-19 worsened these issues, increasing denials and delaying care.

Objectives: This study analyzed interfacility transfer requests, transfer denials, and consultation requests for pediatric services at a large academic regional children's hospital, focusing on the impact of patient surges on transfer denials and the use of telephone and telemedicine consultations to support denials.

Methods: This retrospective study reviewed incoming calls from July 2019 to December 2023 to the UC Davis Children's Hospital transfer center from non-children's hospital emergency departments. Data on transfer requests to the pediatric intensive care unit, neonatal intensive care unit, and pediatric ward were analyzed, focusing on transfer denials due to limited bed space and staffing.

Results: Over the 42-month study period, transfer requests to the pediatric intensive care unit, neonatal intensive care unit, and pediatric ward averaged 279 per month, with 211 accepted and 38 denied per month. Telephone consultations averaged 27 per month, while telemedicine consultations averaged 3.3 per month. In November 2022, during the triple-demic, transfer requests spiked to 640 per month, with denials due to bed/staffing shortages rising to 375 (58.6% of requests). Despite these surges, the number of accepted transfers remained stable.

Conclusions: The data highlight the challenges faced by a large regional children's hospital in managing transfer requests during surges, particularly exacerbated by the triple-demic in late 2022. As pediatric units close nationwide, telephone and telemedicine consultations offer valuable support for managing transfers that cannot be accommodated.