From the Guidelines
The most significant predictors for referral to the Pediatric Emergency Department (ED) include lack of universal understanding and application of a definition of “emergency,” lack of reasonable access to alternative sources of health care, ED crowding and diversion of emergency medical services (EMS), and variability in pediatric training and experience among physicians and nurses staffing EDs. When evaluating the need for referral to the pediatric ED, it is crucial to consider these factors, as they can significantly impact access to timely and appropriate care 1. Some key points to consider in the referral process include:
- Lack of universal understanding and application of a definition of “emergency” can lead to delayed care and increased morbidity
- Limited access to alternative sources of health care can result in ED overcrowding and decreased quality of care
- ED crowding and diversion of EMS can further exacerbate delays in care and worsen outcomes
- Variability in pediatric training and experience among ED staff can impact the quality of care provided to children Given these considerations, a comprehensive approach to referral should prioritize timely assessment and stabilization, with clear communication and coordination between healthcare providers and ED staff. This approach should be guided by the principles outlined in the American Academy of Pediatrics' commitment to improving access to emergency care for children, as described in the study published in Pediatrics in 2007 1. Key elements of this approach include:
- Standardized assessment and triage protocols
- Clear guidelines for ED referral and transfer
- Ongoing education and training for healthcare providers on pediatric emergency care
- Quality improvement initiatives to address ED crowding and diversion of EMS.
From the Research
Predictors for Referral to the Pediatric Emergency Department (ED)
- The decision to refer a patient to the Pediatric ED is often based on the severity of the illness, with more severe cases being referred by primary care providers 2
- Young infants, patients with respiratory or neurological problems, and sicker patients with fever or infections are more likely to be assessed by physicians in the ED 3
- Patients with certain chief complaints, such as abdominal pain, extremity injury, fever, cough/cold, and head/neck injury, are more likely to be referred to the ED from urgent care centers 4
- Referral by a primary care provider to a PED is significantly and independently associated with greater severity of illness and resource utilization 2
- The use of electronic referral (eReferral) and electronic consultations (eConsult) can help improve access to specialty pediatric care and reduce wait times 5
Factors Influencing Referral Decisions
- Clinical urgency and medical priority are key factors in determining whether a patient should be referred to the ED 3
- The time of day and day of the week can also influence referral decisions, with more patients being referred during evenings and weekends 3
- The availability of experienced pediatric nurses and the use of standardized workflows can help facilitate the referral process and improve patient outcomes 3, 5
Common Reasons for Referral
- Respiratory distress, altered consciousness, seizure, and shock are common manifestations of non-traumatic pediatric emergencies that may require referral to the ED 6
- Abdominal pain, fever, and respiratory complaints are common reasons for referral to the PED 2
- Closed extremity fracture, gastroenteritis, brain concussion, upper respiratory infection, and nonsurgical, unspecified abdominal pain are common primary diagnoses among patients referred to the ED from urgent care centers 4