Association between emergency department pediatric readiness and transfer of noninjured children in small rural hospitals

Monica K. Lieng, James P. Marcin, Ilana S. Sigal, Sarah C. Haynes, Parul Dayal, Daniel J. Tancredi, Marianne Gausche-Hill, Jamie L. Mouzoon, Patrick S. Romano, Jennifer L. Rosenthal

Research output: Contribution to journalArticlepeer-review


Purpose: Pediatric readiness scores may be a useful measure of a hospital's preparedness to care for children. However, there is limited evidence linking these scores with patient outcomes or other metrics, including the need for interfacility transfer. This study aims to determine the association of pediatric readiness scores with the odds of interfacility transfer among a cohort of noninjured children (< 18 years old) presenting to emergency departments (EDs) in small rural hospitals in the state of California. Methods: Data from the National Pediatric Readiness Project assessment were linked with the California Office of Statewide Health Planning and Development's ED and inpatient databases to conduct a cross-sectional study of pediatric interfacility transfers. Hospitals were manually matched between these data sets. Logistic regression was performed with random intercepts for hospital and adjustment for patient-level confounders. Findings: A total of 54 hospitals and 135,388 encounters met the inclusion criteria. EDs with a high pediatric readiness score (>70) had lower adjusted odds of transfer (aOR: 0.55, 95% CI: 0.33–0.93) than EDs with a low pediatric readiness score (≤ 70). The pediatric readiness section with strongest association with transfer was the “policies, procedures, and protocols” section; EDs in the highest quartile had lower odds of transfer than EDs in the lowest quartile (aOR: 0.54, 95% CI: 0.31–0.91). Conclusions: Pediatric patients presenting to EDs at small rural hospitals with high pediatric readiness scores may be less likely to be transferred. Additional studies are recommended to investigate other pediatric outcomes in relation to hospital ED pediatric readiness.

Original languageEnglish (US)
JournalJournal of Rural Health
StateAccepted/In press - 2021


  • access to care
  • emergency medical care
  • pediatric readiness
  • quality
  • utilization of health services

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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