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In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
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Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
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In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses...
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Surgical Management of Meatal Stenosis with Meatoplasty
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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
Summary

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.

Keywords:
InappropriatePediatric surgeryReferral

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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.