Patterns of Avoidable Pediatric General Surgical Referrals in a Rural State
Savannah C Walker1, Esma Birisci2, Deidre L Wyrick1
1Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Division of Pediatric Surgery, Arkansas Children's Hospital, Little Rock, Arkansas.
Insights
Nearly a quarter of pediatric surgical referrals are avoidable, leading to healthcare inefficiencies. Targeted screening before outpatient visits can improve pediatric specialty care access and resource use.
Area of Science:
- Pediatric Surgery
- Healthcare Management
- Health Services Research
Background:
- Avoidable referrals for pediatric general surgery lead to inefficient healthcare use and burdens for families.
- Characterizing factors associated with avoidable referrals is crucial for optimizing pediatric surgical care access.
Purpose of the Study:
- To identify patient and referring provider characteristics linked to avoidable outpatient pediatric general surgical referrals in a rural setting.
- To analyze the impact of avoidable referrals on healthcare utilization and patient outcomes.
Main Methods:
- Multisite retrospective cohort study of pediatric patients (<18 years) referred for outpatient general surgery.
- Defined avoidable referrals as those not requiring in-clinic procedures, imaging, operations, or follow-up within one year.
- Employed bivariate and multivariable logistic regression to assess patient and provider factors associated with avoidable referrals.
Main Results:
- 24% of 5966 referrals were avoidable, with higher rates in younger children (0-3 years).
- Umbilical hernia (39% avoidable) and pectus excavatum (46% avoidable) were common and frequently avoidable referrals.
- Self-pay status and referrals from emergency medicine providers significantly increased the odds of avoidable referrals (OR 2.5 and 1.8, respectively).
- Avoidable referrals had a shorter time from referral to clinic visit (34 vs. 41 days).
Conclusions:
- Nearly one-quarter of pediatric general surgery referrals are avoidable, indicating a need for improved referral processes.
- Implementing targeted screening before outpatient pediatric general surgical evaluations can enhance access to appropriate specialty care and optimize healthcare utilization.
Introduction:
Avoidable referral of children for outpatient pediatric general surgical evaluation creates inefficient healthcare utilization and unnecessary social and financial burdens for patients and families. We sought to characterize patient and referring provider characteristics associated with avoidable patient referrals for outpatient pediatric general surgical evaluation in a rural state.
Methods:
This is a multisite retrospective cohort study including patients <18 y referred for outpatient pediatric general surgical evaluation between November 2017 and July 2024. Avoidable referrals were defined as patients who attended pediatric general surgery clinic but did not require an in-clinic procedure, imaging, operation, or clinic follow-up within 1 y. Bivariate analysis and multivariable logistic regression were performed to evaluate for associations between patient and provider factors and avoidable referral.
Results:
We included 5966 patients. One-quarter of referrals were identified as avoidable (n = 1402, 24%), with children 0-3 y more commonly identified as avoidable (P < 0.001). Umbilical hernia was the most common referral (n = 917); 39% of these were avoidable. Pectus excavatum was most likely to be avoidable (n = 188; 46% avoidable). Referrals for self-pay patients and those placed by emergency medicine providers were more likely to be avoidable [odds ratio 2.5, 95% Confidence Interval (CI) (1.5-4.1) P < 0.001; odds ratio 1.8, 95% CI (1.3-2.7) P < 0.001]. Avoidable referrals had a shorter average time from referral to outpatient pediatric general surgery clinic visit (34 versus 41 d, P < 0.001).
Conclusions:
Nearly one-quarter of referrals were identified as avoidable. Development of targeted screening prior to outpatient pediatric general surgical evaluation may improve access to pediatric specialty care for indicated referrals and appropriate healthcare utilization.
