Emergency Department Pediatric Readiness and Potentially Avoidable Transfers.

Objective To determine the association between potentially avoidable transfers (PATs) and emergency department (ED) pediatric readiness scores and the score's associated components. Study design This cross-sectional study linked the 2012 National Pediatric Readiness Project assessment with individual encounter data from California's statewide ED and inpatient databases during the years 2011-2013. A probabilistic linkage, followed by deterministic heuristics, linked pre-transfer and post-transfer encounters. Applying previously published definitions, a transferred child was considered a PAT if they were discharged within one day from the ED or inpatient care and had no specialized procedures. Analyses were stratified by injured and non-injured children. We compared PATs with necessary transfers using mixed-effects logistic regression models with random intercepts for hospital and adjustment for patient and hospital covariates. Results After linkage, there were 6675 injured children (27% PATs) and 18 793 non-injured children (14% PATs) who presented to 283 hospitals. In unadjusted analyses, a ten-point increase in pediatric readiness was associated with lower odds of PATs in both injured (OR: 0.93, 95% CI: 0.90-0.96) and non-injured children (OR: 0.90, 95% CI: 0.88-0.93). In adjusted analyses, a similar association was detected in injured patients (aOR: 0.92, 95% CI: 0.86-0.98) and was not detected in non-injured patients (aOR: 0.94, 95% CI 0.88-1.00). Components associated with decreased PATs included having a nurse pediatric emergency care coordinator and a quality improvement plan. Conclusions Hospital ED pediatric readiness is associated with lower odds of a PAT. Certain pediatric readiness components are modifiable risk factors that EDs could target to reduce PATs.