Impact of a Novel Referral Program From a Children's Hospital Emergency Department to Primary Care: Does Referral...

Interventions to connect pediatric Emergency Department (PED) patients to primary care are needed to improve preventive care access and reduce ED overcrowding. This study aimed to assess the impact of a novel PED-to-primary care referral program on preventive care utilization and ED and hospital visit rates.

We instituted a new electronic referral program in which clinicians referred PED patients lacking or requesting a new primary care physician (PCP) to a partner federally qualified health center (FQHC) network. We then conducted a retrospective chart review of all referred patients between January 2020 (program inception) and June 2022 to evaluate the program in two ways. For all referrals, we assessed operational metrics: the number of patients referred, reached by phone, scheduled for an appointment, and completed an appointment. For the first 500 referrals, we further evaluated demographic characteristics associated with appointment completion, preventive care services received, and the number of post-referral ED visits and hospitalizations.

Overall, the PED referred 1778 patients. FQHC family navigators successfully contacted 1293 patients within 3 days. Of those contacted, 576 had appointments scheduled, and 372 patients (20.9% of total referrals) completed an appointment within 30 days. Among the first 500 referrals, no demographic characteristics were associated with appointment completion. Patients who completed an appointment presented with immunization delays, abnormal hemoglobin or lead levels, and food insecurity. We found no reduction in ED or hospital utilization postreferral.

While less than one third of referred PED patients completed timely primary care physician appointments, those who did demonstrated significant preventive service needs. Further studies should explore the substantial attrition between PED referral and PCP appointment completion.