2022 SAEMF/RAMS Resident Research Grant - $5,000

One in every twelve Americans is diagnosed with asthma, making it the most prevalent chronic respiratory disease in the United States. Asthma is also the most common chronic medical condition among children, affecting 7.5% of the overall pediatric population.  Children have 105 emergency department (ED) visits for asthma per 10,000 population per year, a rate more than three times greater than for adults. Many pediatric ED visits for asthma each year result in hospital admission, either to the inpatient service at the initial facility or through an interfacility transfer to another hospital. Interfacility transfers are typically initiated by ED providers, citing a need for a higher level of care (i.e., critical care), recommendation of specialty services (e.g., pediatric pulmonology), or capacity-related limitations (i.e., current availability of beds or other resources). Prior research has identified asthma as the most common primary medical diagnosis associated with interfacility transfer for pediatric patients; however, many interfacility transfers are potentially unnecessary. Prior work showed that more than 40% of pediatric transfers were either discharged directly from the receiving ED or within 24 hours of direct admission upon transfer. Interfacility transfers are associated with missed doses of medication, prolonged time to initiation of inpatient care, and a substantial financial burden on families.

Despite the commonplace nature of pediatric transfers for asthma in the ED, there is no prior literature to describe the specific factors associated with this routine practice or to advise emergency physicians in their decision making. This project aims to use a large dataset of all ED and inpatient discharges in California to describe the healthcare-system-related and patient-related factors associated with potentially unnecessary pediatric transfers for asthma. The overarching goal of this one-year project will be to provide specific, practical guidance to ED providers and administrators regarding the optimal use of interfacility transfers to best serve pediatric patients with asthma and their families.