Fewer Community Hospitals Admit Kids With Common Ailments

By Lisa Rapaport

March 18, 2020

(Reuters Health) - With hospital care for complex pediatric illnesses increasingly concentrated at large medical centers, children who go to local emergency departments for common problems like asthma, croup or gastroenteritis are more likely these days to be transferred to a different hospital if they need to be admitted, a U.S. study suggests.

"It is possible that some community hospitals have closed their inpatient pediatric units which means that they can't admit kids to their own hospital and have to transfer any kids that need to stay in the hospital," said coauthor Dr. Anna Cushing of Boston Children's Hospital and Boston Medical Center.

"It is also possible that kids who go to emergency departments are more sick, on average, than before, possibly because we are doing a better job of keeping the less-sick patients at pediatric clinics and urgent cares and out of the emergency department," Cushing said by email.

So-called regionalization in the U.S. hospital industry has intentionally concentrated specialized pediatric care at certain hospitals - often academic medical centers or trauma centers - that are set up to handle complex injuries and illnesses.

The upside of this approach is that specialty services are concentrated at hospitals with the equipment and clinicians needed to handle rarer and more complex cases.

While previous studies have found that kids get better trauma care at specialized pediatric trauma centers, less is known about how regionalization has impacted care for kids with less complex health problems.

In the current study, researchers wanted to see how regionalization might impact care for kids with less-complicated medical issues who still might need to be admitted to the hospital. They focused on three common problems that often fall in this category: asthma, croup and gastroenteritis.

At hospitals with the fewest pediatric patients, they found, the proportion of kids with asthma transferred from the ER to other hospitals rose by 14% a year from 2008 to 2016. Over that same period, transfers for croup climbed 15% a year and transfers for gastroenteritis increased 16% annually.

The results suggest that fewer community hospitals are able to admit kids with these common problems that can be relatively straightforward to diagnose, the study team concludes in Pediatrics.

One limitation of the study is that researchers lacked data on individual patients, so they can't tell exactly why some kids might get transferred while other children were not, the authors note.

Parents should keep in mind the possibility that kids might get transferred and, when they have a choice, consider going to a hospital where they know pediatric care is available, said Dr. Fizan Abdullah of Northwestern University and the Ann & Robert H. Lurie Children's Hospital of Chicago.

"Conventional wisdom states that all hospitals are able to take care of common pediatric conditions that do not typically require the care of a subspecialist," Abdullah, who wasn't involved in the study, said by email. "However, this study shows that transfer rates for common pediatric conditions such as asthma, croup and gastroenteritis vary greatly among hospitals."

SOURCE: https://bit.ly/3d9g8tF Pediatrics, online March 13, 2020.