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Inappropriate referrals in pediatric surgery

Laura A Shinkunas1, Caleb J Klipowicz2, Erica M Carlisle3

  • 1University of Iowa Carver College of Medicine, Program in Bioethics and Humanities, Iowa City, IA, USA.

Journal of Pediatric Surgery
|July 15, 2020
PubMed

Insights

Nineteen percent of pediatric surgery referrals are inappropriate, often stemming from mid-level or non-pediatric providers. Addressing this can optimize health-system resources and improve patient care pathways.

Area of Science:

  • Pediatric Surgery
  • Healthcare Resource Management
  • Referral Systems

Background:

  • Inappropriate patient referrals to pediatric surgeons strain health-system resources.
  • Existing policy statements from organizations like the American Academy of Pediatrics aim to guide appropriate surgical referrals.
  • This study quantifies the volume and characteristics of inappropriate referrals to pediatric surgeons.

Purpose of the Study:

  • To identify the prevalence and key characteristics of inappropriate referrals within a pediatric surgery setting.
  • To analyze factors contributing to inappropriate referrals, including provider type, patient demographics, and diagnosis.
  • To understand the impact of inappropriate referrals on patient travel distance.

Main Methods:

  • Retrospective chart review of new patients in a tertiary-care children's hospital's Pediatric Surgery Clinic over 12 months.
  • Abstraction and coding of patient demographics, insurance, referring provider specialty, and diagnosis as appropriate or inappropriate.
  • Statistical analysis, including odds ratios (OR), to identify factors associated with inappropriate referrals.

Main Results:

  • 19% of 509 identified referrals were deemed inappropriate.
  • Inappropriate referrals were more frequent from mid-level providers (OR=1.97) and non-pediatric specialists (OR=1.94).
  • Female and younger patients were more likely to receive inappropriate referrals; common diagnoses included umbilical hernia and GI complaints. Inappropriately referred patients traveled farther (57.8 miles average).

Conclusions:

  • Despite established guidelines, a significant proportion (19%) of pediatric surgery referrals remain inappropriate.
  • Strategies to reduce inappropriate referrals include enhanced supervision of mid-level providers and pediatric-focused training.
  • Implementing a system for referral to local pediatricians before surgical consultation could mitigate unnecessary referrals.
Abstract

Keywords:
InappropriatePediatric surgeryReferral

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