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Children referred to an emergency department by an after-hours call center: complaint-specific analysis
Richard J Scarfone1, Anthony A Luberti, Rakesh D Mistry
1Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. Scarfone@email.chop.edu
Insights
Children referred to the emergency department (ED) for lower respiratory issues are often acutely ill. However, many referrals for other conditions, like gastrointestinal or upper respiratory problems, may not require urgent care, suggesting a need to revise referral criteria.
Area of Science:
- Pediatrics
- Emergency Medicine
- Public Health
Background:
- After-hours call centers refer approximately 20% of calls to the emergency department (ED).
- Limited data exist on the management and disposition of children referred to the ED by these centers.
- Understanding the acuity of referred pediatric patients is crucial for optimizing healthcare resource allocation.
Purpose of the Study:
- To determine the acuity of illness in children referred to the ED by after-hours call centers.
- To analyze ED management and disposition based on chief complaints.
- To stratify findings by specific chief complaint categories.
Main Methods:
- Retrospective analysis of patients referred to the ED by after-hours call centers without prior physician consultation.
- Identification of the four most common chief complaint groups leading to ED referral.
- Analysis of triage classifications, therapeutic interventions, diagnostic testing, and hospitalization rates.
Main Results:
- Lower respiratory tract complaints (50%) were associated with higher triage priorities, interventions, diagnostic testing, and hospitalizations compared to other categories.
- Gastrointestinal complaints (20%) often required intravenous fluids for dehydration.
- Head, ears, eyes, nose, and throat (16%) and upper respiratory tract (14%) complaints frequently resulted in non-urgent referrals.
Conclusions:
- Children referred for lower respiratory issues, particularly wheezing, present with high acuity illnesses.
- Current referral criteria for gastrointestinal, ENT, and upper respiratory complaints may lead to unnecessary ED visits for non-urgent conditions.
- Reassessment of referral practices for pediatric patients with these chief complaints is warranted to improve efficiency and resource utilization.
Background And Objectives:
Approximately 20% of phone calls to after-hours call centers result in referrals to the emergency department (ED), but data regarding ED management and disposition are lacking. We sought to determine the acuity of illness of referred children as reflected by triage classifications and need for therapeutic interventions, diagnostic testing, and hospitalization, and to stratify the analysis of ED management and dispositions by chief complaints.
Design And Methods:
Patients referred to the ED by the after-hours call centers, without physician consultation, were identified. The 4 most common groups of chief complaints resulting in ED referral were determined, and the records of these children were analyzed.
Results:
The 525 patients with chief complaints related to the following organ systems were studied: lower respiratory tract, 263 (50%); gastrointestinal, 104 (20%); head, ears, eyes, nose, and throat, 84 (16%); and upper respiratory tract, 74 (14%). The proportion of children referred for lower respiratory tract complaints who received the after-hours call centers call dispositions (99%) or ED triage classifications (38%) of highest priorities, or who required therapeutic interventions (73%), diagnostic testing (40%), or hospitalization (22%) was significantly higher than for all other categories. Thirteen percent with gastrointestinal complaints, referred primarily for dehydration, required intravenous fluids, and 2% of head, ears, eyes, nose, and throat patients required hospitalization.
Conclusions:
Children referred to the ED for illnesses related to the lower respiratory tract, principally wheezing, had illnesses of high acuity. On the other hand, current criteria for ED referral for children in the gastrointestinal, head, ears, eyes, nose, and throat, and upper respiratory tract categories result in the referral of many children with nonurgent problems. These data support a reassessment of current referral practices for children with these complaints.
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