(818) Patterns of Rural Pediatric ICU Transfers for Quaternary Services

Introduction: In recent years, US hospital-based pediatric care has faced significant challenges due to the ongoing closure of pediatric inpatient units, including PICUs. This trend has led to increased travel distances for families seeking medical care, particularly in rural areas. We evaluated baseline practice patterns within a rural healthcare system by examining transfers from a single tertiary PICU to the nearest quaternary center located out-of-state.

Methods: Descriptive case series of all transfers between Oct 2015 to Dec 2022 from a rural academic tertiary PICU with an average of 417 admissions annually. Medical records of these transfers were reviewed and categorized by primary diagnosis and reason for transfer. Characteristics of the transfers were summarized. Transfers to other tertiary PICUs nearer to patients’ families and transfers to long-term care units were excluded.

Results: Out of 2,916 consecutive admissions, 39 transfers (1.3%) were made to the quaternary center. Cardiac procedures were the most common reason for transfer (n=16, 41%), including surgical (n=4), interventional (n=5) and diagnostic catheterizations (n=2), electrophysiology studies (n=4), and mechanical heart failure support (n=1). Seven transfers (18%) were for neurosurgical procedures, including intracranial masses (n=4), spinal surgery (n=2), and trauma (n=1). Five children (13%) were referred for consideration for extracorporeal life support (ECLS) due to refractory respiratory failure (n=3) or circulatory failure (n=2). Other reasons included transplant assessment (n=4), renal replacement therapy (n=2), family request (n=2), refractory gastrointestinal disease (n=1), complications following stem-cell transplant (n=1), and progressive genetic conditions (n=1). Six of the transfers (15%) were for medical evaluations that might have been suitable for telehealth, potentially avoiding the need for interstate transfer.

Conclusions: This case series indicates that 98.7% of children served by a rural tertiary PICU were able to remain in their community, thus avoiding the cost and distance associated with transfers. The findings underscore the capacity of a single rural tertiary PICU to address the majority of critical care needs of its community and highlight the importance of sustaining support for rural pediatric centers.