Avoidable Out-of-Region Treatment in Florida: Opportunities for Pediatric Trauma System Improvement
Christopher Snyder1, Nicole Chandler1, Etienne Pracht2, David Ciesla3, Paul Danielson1
1Johns Hopkins All Children's Hospital, St Petersburg, FL;2University of South Florida College of Public Health, Tampa, FL;3University of South Florida College of Medicine, Tampa, FL
Background: Florida’s regionalized pediatric trauma system contains two less-populated regions (North and Southwest) that do not have a pediatric trauma center (PTC). Patients in these two regions are frequently transferred out of their home region for definitive treatment, and previous work has shown that many of these transfers may be avoidable. This study described patients receiving avoidable out-of-region treatment (AORT) and investigated variations between the North and Southwest regions.
Methods: We identified all pediatric trauma patients (<=15 years old) admitted 2009-2014 using the Florida Agency for Health Care Administration database, which captures all hospital admissions in the state. Patients were characterized as AORT if they received definitive treatment at a facility outside their home region, but had low risk injuries (ICISS>0.9), required no procedures or ICU monitoring, and were discharged within 48 hours. Demographics, principal diagnoses, and resource usage data were evaluated and compared between regions.
Results: A total of 609 patients received AORT during the study period. Median age was 4 years (IQR, 1-11), 62% were male, and mean annual inpatient charges were $870,372 (SD $148,988). The most common diagnoses were skull fractures (n=156, 26%), burns (n=88, 14%), and uncomplicated concussions (n=82, 13%). Comparing the two regions, burns were most common in the North (29% vs. 11%, p<0.0001), whereas skull fractures predominated in the Southwest (42% vs. 17%, p<0.0001).
Conclusions: Skull fractures, burns, and uncomplicated concussions make up the majority of avoidable out-of-region transfers. These diagnoses represent an opportunity for system improvement utilizing provider education, inter-institutional protocols, and telemedicine. Knowledge of regional variations allows precise targeting of improvement efforts.
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