The Effect of Employing an Emergency Medicine Specialist in the Emergency Department of a Rural District State Hospital on Transfer to a Higher-Level Center and Hospital Admission in Pediatric Patients: A Retrospective Before–After Study

Background: In rural Türkiye, district state hospital emergency departments are staffed by general practitioners, who decide on transfers. The authors investigated the effect of a full-time emergency medicine specialist in such a hospital on pediatric transfer to a higher-level center, admission, and diagnostic profile of transfers. Methods: This single-center, retrospective before–after study compared all emergency visits by patients younger than 18 years in the 12 months before and after the specialist took up duty on June 1, 2025. The primary outcome was transfer to a higher-level center; secondary outcomes were admission, diagnostic profile of transfers, 72-hour return visits, and emergency department length of stay. Transfer diagnoses were classified by hospital capacity. Multivariable logistic regression and interrupted time series models were used. Results: Overall, 36 064 emergency visits by 12 184 unique children were included. The transfer rate increased from 1.20% to 1.47% (adjusted odds ratio [OR]: 1.27; 95% CI: 1.05-1.53); admission (1.12% and 1.01%) and 72-hour return (7.08% and 7.02%) rates were unchanged. Among transfers, diagnoses requiring a specialty unavailable at the hospital rose from 14.0% to 26.6% and nonspecific diagnoses fell from 71.9% to 57.1% (P = .001). Transfers requiring a specialty increased from 1.7 to 3.9 per 1000 visits (adjusted OR: 2.07; 95% CI: 1.33-3.24). Median time to the transfer decision increased from 45 to 65 minutes (P = .02). Conclusion: An emergency medicine specialist did not reduce pediatric transfers; the changed transfer profile and longer decision time potentially indicate improved transfer selection and more extensive on-site evaluation. Cite this article as: Tavrak E, İşleyen ÖF, Tortum F. The effect of employing an emergency medicine specialist in the emergency department of a rural district state hospital on transfer to a higherlevel center and hospital admission in pediatric patients: a retrospective before–after study. Eurasian J Med. 2026, 58(4), 1802, doi: 10.5152/eurasianjmed.2026.261802.