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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, MS; Lucille G. Cheng, BA; Nicolás M. Kass, BA; Angel Dixon, BS; Anne E. Glenney, BA; Jesse A. Goldstein, MD
University of Pittsburgh School of Medicine
2024-01-14
Presenter: Shirley X. Liu, MS
Affidavit:
All of the work on this project represents the original work of the medical student.
Director Name: Jesse Goldstein
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
PURPOSE: 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. Variables studied included demographics, provider credentials, pre-transfer facility, and transportation modality. PAT was defined as a patient with a stay less than one day, and no admission, surgery, or emergent procedure post-transfer.
RESULTS: Of 75 patients, 37 met PAT criteria. Provider credentials (p = 0.013) and initial presenting facility type (p = 0.024) were significantly associated with PAT. Patients initially seen by APPs had increased odds of PAT compared to those initially 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 estimated PAT cost per patient was $6,332.11, with imaging at $5,844.66 (92.3% of total cost) and transportation at $487.45 (7.7%).
CONCLUSIONS: 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.
