O3290: Changes in Volume and Distance for Pediatric Transfers 2019-2022: Influence of the COVID-19 Pandemic

Background: Admissions at children's hospitals fluctuated during the COVID-19 pandemic. The RSV surge in late 2022 exceeded pediatric bed capacity creating hardship to families due to long distance to the nearest available pediatric beds. We evaluated changes in transfer volume and distance throughout the pandemic and compared to adult transfers.

Methods: We analyzed incoming transfer activity among adult (18+y) and pediatric cases (0-17y) in 79 tertiary medical centers with pediatric programs and 10 pediatric specialty hospitals in the Vizient® Clinical Data Base. Hospitals with inpatient data submitted every month from 2019 to 2022 were queried. Birth admissions were excluded. Transfer rate was defined as inbound transfers/overall admissions. Viral bronchiolitis was defined by ICD-10 codes J210, J218, J219. Distance traveled was calculated as the distance in miles between the center of the patient’s home 5-digit zip code and the center of the hospital 5-digit zip code. Mann-Kendall trend tests were used to assess periodic changes.

Results: Adult admissions declined 6% during the study period and the average adult transfer rate declined 10% from 2019-2022 (12.6% to 11.4%) (Table 1). The median distance transferred remained flat at 36 miles (Figure 1a). By contrast, pediatric admissions markedly decreased from 2019 (349,071) to 2020 (276,525) and increased in 2022 (352,939) to pre-pandemic levels (Table 1). The average pediatric transfer rate is significantly higher than the adult transfer rate and remained flat at 24% (Table 1), but the median transfer distance increased 12% from 2019-2022 (30.0 miles to 33.6) (Figure 1a). Transfer distance among pediatric viral bronchiolitis cases markedly increased in 2020 and remained elevated through 2022 (Figure 1a). 58% of hospitals in the sample were in large metros with significantly shorter travel distances among transfer and non-transfer admissions than non-large metro hospitals (Table 1b). Transfer distance of pediatric patients with Medicaid increased 17% from 2019-2022 (30.9[11.9-63.2] to 36.2[13.9-68.7] miles), significantly more than the 9% increase in transfer distance of pediatric patients with commercial insurance (27.1[13.5-58.1] to 29.6[15.0-60.7] miles). Segmented by race and payer, white pediatric patients with Medicaid were transferred the greatest distance (44.8[23.3-76.5] miles) in 2022, up 22% from 2019 (36.7[16.4-67.7] miles), with distance transferred growing across all groups (Figure 1b). All periodic transfer rates were statistically significant (P <.001). Among the children’s hospitals, location (large metropolitan vs. other) influenced distance traveled.

Conclusion: In contrast to adult admission and transfer trends, pediatric admissions rebounded to pre-pandemic levels in 2022 without any change in transfer rate but with a 12% increase in transfer distance. Transfer distances increased across all pediatric payer/race segments. Distance traveled by patients in non-metro areas is significantly higher compared to metro regions, highlighting urban/rural access disparities and burden on families. Increasing pediatric bed capacity in community hospitals is needed to limit hardship on families.