No abstract

Objective Every year, emergency medical services agencies transport approximately 150,000 pediatric patients between hospitals. During these transitions of care, patient safety may be affected and contribute to adverse events when important clinical information is missing, incomplete, or inaccurate. Written interfacility transfer policies are one way to standardize procedures and facilitate communication between the hospitals leading to improved patient safety and satisfaction for children and families. Methods We assessed the presence and components of written interfacility transfer guidelines and agreements for pediatric patients via a survey sent to US hospital emergency department (ED) nurse managers during 2010 and 2013. Results Although there was an increase in the presence of written interfacility transfer guidelines and agreements, a third of hospitals did not have either by 2013, and only 50% had guidelines with all recommended pediatric components. Hospitals with medium and low ED pediatric patient volumes were less likely to have written guidelines or agreements compared with hospitals with high volume. Hospitals with advanced pediatric resources, such as a pediatric emergency care coordinator or EDs designated approved for pediatrics, were more likely to have guidelines or agreements than less resourced hospitals. Conclusions Although there was improvement over time, opportunities exist for increasing the presence of written interfacility transfer guidelines as well as agreements for pediatric patients. Further studies are needed to demonstrate whether improved delivery of patient care is associated with the presence of written interfacility transfer guidelines and agreements and to identify other elements in the process to ensure optimal pediatric patient care.

This study compared information gathered from medical examiner reports to information gathered from law enforcement reports in characterizing incidents of homicide and homicide followed by suicide that were abstracted for a public health violent-death surveillance system. The authors found that law enforcement reports contribute substantively to the surveillance system and often augment or provide additional information to the medical examiner reports. The utility of law enforcement data, particularly the narrative information, must be balanced with the time needed to gather the law enforcement reports and funding limitations. As violent-death surveillance needs grow, linking police and other law enforcement data with medical examiner and other public health data sources will provide a clearer picture of the circumstances relating to homicide and other violent deaths at the state and national level.