Travel Distances for Interhospital Transfers of Critically Ill Children: A Geospatial Analysis.

Importance: The U.S. pediatric acute care system has become more centralized, placing increasing importance on interhospital transfers.

Objectives: 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.

Main outcomes and measures: 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.

Results: 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.

Conclusions and relevance: 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.