Stay Put or Move Out? A Review of Acute Respiratory Illness Transfers Out of a Peripheral Centre and Their Characteristics: A Retrospective Cohort Study

TL;DR

This study examines children transferred out of a peripheral hospital for acute respiratory illnesses and finds that many could be managed locally, especially those with preschool asthma or on high flow nasal therapy.

Contribution

The study identifies specific patient characteristics that could allow for decentralizing pediatric high dependency care.

Findings

Preschool asthma and high flow nasal prong therapy were strong predictors of transfers that could be managed at a peripheral center.

62.4% of patients received high flow nasal prong therapy before transfer.

Only 19.4% of all transfers met the study's inclusion criteria for acute respiratory illness.

Abstract

To describe the characteristics of children transferred out of a peripheral centre for the management of acute respiratory illness and explore opportunities for decentralising paediatric high dependency care.

A single‐centre, retrospective cohort study, including children transferred out of a peripheral centre with diagnoses of asthma, bronchiolitis, pneumonia and pleural effusion. Patient characteristics and management were recorded from the medical records. Transfers were classified as ‘within scope’ and ‘outside scope’ of a peripheral paediatric centre. A multivariate regression was used to identify predictors of within scope transfers.

Between September 2015 and September 2023, there were 852 transfers, of which 165 (19.4%) met the study inclusion criteria. Ninety‐three (56.4%) transfers were within scope. Pre‐transfer diagnoses of preschool asthma, bronchiolitis, use of high flow nasal prong therapy (HFNP) and transfer directly from the emergency department (rather than ward) were more common for within scope transfers. HFNP was used in 103 (62.4%) of patients, including 74 (79.6%) of within scope transfers. Within scope transfers were predicted by preschool asthma (aOR 17.1, 95% CI 2.1–142.2, p = 0.01) and HFNP therapy pre‐transfer (aOR 5.4, 95% CI 2.2–13.2, p < 0.0001).

This study shows a cohort of patients that could benefit from a model of care involving decentralising paediatric high dependency care, particularly children with preschool asthma, and those transferred for closer monitoring on HFNP therapy. More work needs to be done to define the scope of practice, guidelines and training, staffing and resourcing and systems for safety netting.

Figures