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Provider Characteristics and Pre-Transfer Costs of Potentially Avoidable Transfers for Pediatric Facial Fracture Patients In a Single Institution
Shirley X. Liu
*1, Lucille Cheng
1, Nicolás M. Kass
2, Angel Dixon
2, Anne E. Glenney
2, Jesse A. Goldstein
21School of Medicine, University of Pittsburgh, Pittsburgh, PA; 2Department of Plastic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
BACKGROUND: Among some types of common pediatric facial fractures, conservative treatment is the most typical and readily available treatment method. However, patients may still be transferred, leading to costly and potentially "avoidable" transfers (PAT). This study identifies provider characteristics and initial presenting facility type associated with PAT, and the resulting financial burden borne by the patients.
METHODS: Records of patients who presented to a pediatric level I trauma center after inter-hospital system transfer of a facial fracture were retrospectively reviewed. The primary outcome examined was a PAT, defined as a patient with a length of stay less than one day, with no admission, surgery, or emergent procedure performed post-transfer. Variables studied included demographics, provider credentials, pre-transfer facility, and transportation modality.
RESULTS: Of the 175 identified patients who met the inclusion criteria, 73 had accessible electronic medical records available and 37 were PAT. Characteristics significantly associated with PATs include provider credentials (p = 0.013) and the initial presenting facility type (p = 0.024). An increased odds of initiating a PAT is observed in patients who initially presented to Advanced Practice Providers (APPs), including Nurse Practitioners and Physician Assistants, compared to those who presented to MD/DOs (OR = 3.17, 95% CI [1.17, 8.54]). Additionally, there is a significant difference in the likelihood of PAT when initially presenting to trauma center EDs compared to non-trauma center EDs (p = 0.024). The total estimated cost per PAT patient, which included expenses for imaging and transportation, amounted to $6,332.11, where imaging expenses accounted for $5,844.66 (92.3% of total cost) and transportation costs amounted to $487.45 (7.7%).
CONCLUSION: Emergent transfer in pediatric facial fracture patients is often unnecessary. Our findings highlight the significance of provider and facility characteristics associated with PATs, offering avenues to reduce PATs through provider and facility training.
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