Easing the strain on a pediatric tertiary care center: use of a redistribution system.

OBJECTIVE To evaluate the ability of a regionalized system to safely transfer patients requiring admission from a referral center to either regional or community hospitals. DESIGN Cohort study of children requiring admission. Following transfer, a questionnaire was administered to eligible caregivers. Subsequent emergency department (ED) use was assessed by comparing children who were transferred with those who were not. SETTING The Hospital for Sick Children, Toronto, Ontario, Canada, from April 1, 2003, through March 31, 2004. PARTICIPANTS Caregivers of 371 children who underwent transfer from a tertiary care center ED to either a regional or a community hospital were eligible; 344 were contacted. Two hundred fifty-three children for whom transfer was considered but was not performed served as a comparison group. Intervention Questionnaire administered to caregivers, combined with database review. MAIN OUTCOME MEASURES Failure of the transfer process, caregiver satisfaction, and future tertiary care center ED use. RESULTS Five children experienced intravenous access problems, and 4 children experienced delayed antibiotic administration. Caregiver satisfaction was 92.3% with the transfer process and 84.4% with the care at the receiving hospital. Forty-seven percent of caregivers indicated that they would agree to a similar transfer in the future. Two years later, fewer transferred children (39.9%) than those who were not transferred (49.6%) had revisited the tertiary care center ED (odds ratio, 1.52; 95% confidence interval, 1.10-2.10). The mean number of visits was unchanged (95% confidence interval of the difference, -0.44 to 0.21 visits). CONCLUSIONS Although we found the redistribution program to be safe, caregivers stated a preference not to be transferred again. The redistribution system did not substantially alter tertiary care center ED use.