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Informing diversion strategy: A comparison of parent and general practitioner-referred paediatric patients presenting
Robert Millar1,2, Bethany Palmer1, Amelia Chiappazzo1
1The University of Melbourne, Melbourne, Victoria, Australia.
Insights
Parent-referred children attending the emergency department (ED) showed similar characteristics and outcomes to those referred by a general practitioner (GP). This suggests referral source may not be a reliable factor for ED diversion strategies.
Area of Science:
- Pediatric Emergency Medicine
- Health Services Research
- Clinical Triage
Background:
- Understanding referral patterns is crucial for optimizing emergency department (ED) resource allocation.
- Differentiating between parent-referred and general practitioner (GP)-referred pediatric patients may inform diversion strategies.
- Metropolitan teaching hospitals manage a diverse range of pediatric cases, necessitating efficient patient flow.
Purpose of the Study:
- To compare the clinical characteristics and healthcare outcomes of children self-referred by parents versus those referred by a general practitioner (GP) to a metropolitan emergency department (ED).
- To evaluate if referral source influences patient disposition and resource utilization within the ED.
- To inform potential policy changes regarding patient diversion from EDs to general practice.
Main Methods:
- A prospective, cross-sectional observational study was conducted.
- Consecutive pediatric patients (<16 years) at a metropolitan teaching hospital ED were enrolled.
- Data collected included demographics, mode of arrival, triage category, and various clinical outcomes such as admission, consultation, treatment times, and procedures.
Main Results:
- No substantial differences were found in age, sex, or triage category between parent-referred and GP-referred children.
- Parent-referred children were more likely to arrive by ambulance (13% vs. 2%).
- Low-urgency GP-referred children had higher rates of procedures and pathology tests compared to parent-referred children, though overall ED-specific care interventions were similar.
Conclusions:
- Parent-referred children attending the ED do not significantly differ in characteristics or outcomes from GP-referred children.
- The findings challenge the current use of referral source and triage categories for determining suitability for general practice diversion.
- Reconsideration of current diversion protocols is recommended to ensure equitable and efficient patient management.
Objective:
To determine whether the characteristics and outcomes of parent-referred children differ substantially from general practitioner (GP)-referred children attending a metropolitan ED.
Methods:
Prospective cross-sectional observational study of consecutive patients aged less than 16 years of age attending a mixed adult and paediatric metropolitan teaching hospital ED in Melbourne. Data collected included patient characteristics (age, sex, arrival mode and triage category) and outcomes (admission, specialty consultation, treatment time >1 h, intravenous or nasogastric therapy, procedural sedation, procedures, imaging studies and pathology collection).
Results:
The outcome data of 4580 patients was analysed. Patients brought by parents directly to the ED did not differ from patients referred by their GP in age, sex, or triage category, but were more likely to arrive by ambulance (13% vs 2%, P < 0.01). Low-urgency GP-referred children were more likely to require a procedure (22% vs 15%, risk difference [RD] 0.07, 95% confidence interval [CI] 0.02-0.13) and pathology tests (13% vs 8%, RD 0.05, 95% CI 0.01-0.1) than parent-referred children, but were similar for other outcomes. The proportion of low-urgency children who had no ED-specific care interventions was not significantly different between the groups (27% vs 32%, RD -0.06, 95% CI -0.11 to 0).
Conclusions:
Children brought to ED directly by their parents or carers did not differ substantially from GP-referred children in their characteristics or outcomes. The use of referral source and triage categories to determine patient suitability for diversion to general practice may need to be reconsidered.
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