Variation in In-Hospital Emergency Transfer Rates Across Pediatric Hospitals

Abstract

BACKGROUND: Clinical deterioration with late escalation, termed emergency transfer (ET), is a key safety metric. However, national benchmarking is limited by variable definitions. We sought to estimate pooled ET rates and assess variation across pediatric hospitals. METHODS: We performed a cross-sectional analysis of ET events (2020-2022) at 7 pediatric tertiary care hospitals. ET was defined as unplanned transfer to the pediatric intensive care unit with intubation, vasopressors, and/or at least 60 mL/kg fluid resuscitation within 1 hour before or after transfer. We calculated ET rates per 10 000 patient-days and as a percentage of total unplanned transfers. RESULTS: Across 1 582 794 patient-days and 11 100 unplanned transfers, we identified 448 ET events. The most common qualifying intervention categories were endotracheal intubation in 236 ETs (53%) and vasopressor initiation in 204 ETs (46%). The pooled ET rate was 2.83 per 10 000 patient-days (95% CI, 2.57-3.11), with significant variation across sites (range, 1.2-5.1; P < .01). The pooled proportion of unplanned transfers meeting ET criteria was 4.04% (95% CI, 3.68%-4.42%), which also varied significantly (P < .01). Variation persisted when restricted to sites already institutionally tracking ETs. Metric definitions varied most regarding fluid thresholds and which medications were included in vasoactive infusion definitions. CONCLUSION: ET rates vary significantly across pediatric hospitals regardless of the denominator used. Variation may be related to the observed differences in ET metric definitions (eg, fluid thresholds) and hospital characteristics (eg, intensive care unit criteria). These pooled estimates provide initial benchmarks, and standardization of the ET metric definition is required to enable reliable interinstitutional comparison.