Potentially Avoidable Pediatric Transfers, Tertiary Hospital-Level Care, and Regional Differences in Referral Burden in Greece: A Retrospective Analysis of Transfer Pathways and Costs.

Background

Pediatric transfers to tertiary hospitals may vary according to geographic origin and referral pathways and may impose substantial healthcare costs. However, data regarding pediatric transfer pathways, tertiary hospital-level care/admission, and transport-related expenditure in Greece remain limited.

Methods

We conducted a retrospective observational study of children aged 0-16 years transferred to a tertiary children's hospital in Athens, Greece, during 2022-2023. Transfers were classified as prehospital emergency medical service (EMS) transports or interfacility transfers. Post-transfer outcomes were analysed using a predefined binary endpoint: ED/short-stay discharge versus tertiary hospital-level care/admission. Potentially avoidable transfers were identified using conservative predefined resource-utilization criteria. Transport costs were analysed descriptively according to transport modality and geographic region.

Results

A total of 423 pediatric transfers were analysed, including 216/423 (51.1%) prehospital EMS transports and 207/423 (48.9%) interfacility transfers. Overall, 224/423 children (53.0%) required tertiary hospital-level care/admission, whereas 199/423 (47.0%) were managed as ED/short-stay discharges. Importantly, only 54/199 ED/short-stay discharge cases met the stricter criteria for potential avoidability, representing 54/423 (12.8%) of all transfers. Ground ambulance accounted for most transfers, whereas air and sea transport accounted for only 12.1% of transfers, but 97.0% of transport-related expenditure. In unadjusted pathway-level analysis, interfacility transfer was associated with higher odds of tertiary hospital-level care/admission than prehospital EMS transport (OR 3.72, 95% CI 2.49-5.57; p < 0.001) and accounted for 93.8% of total transport costs.

Conclusions

Most pediatric transfers resulted in tertiary hospital-level care/admission, and only a minority met the predefined criteria for potential avoidability. A substantially higher proportion of interfacility transfers resulted in tertiary hospital-level care/admission, and these transfers accounted for a disproportionate share of recorded transport expenditure.