Before the Flood

Abstract

Background Transfers of pediatric patients occur to access specialty and subspecialty care, but incur risk, and consume resources. Direct admissions to medical and surgical wards may improve patient experience and mitigate resource utilization. Objective We sought to identify common elements for direct admissions, as well as the pattern of disposition for patients referred to our emergency department (ED). Design A retrospective qualitative analysis of patients transferred to our pediatric hospital for 12 months was performed. Different physician groups were evaluated for use of direct admissions or evaluation in the ED. Patients referred to the ED were additionally tracked to evaluate their eventual disposition. Results A total of 3982 transfers occurred during the 12-month analysis period. Of those, 3463 resulted in admission, accounting for 32.55% of all admissions. Transfers accepted by nonsurgical services accounted for 82% of the transfers, whereas 18% were facilitated by one of the surgical services. Direct admissions accounted for 1707 (44.8%) of all referrals and were used more often by nonsurgical services. Of patients referred to the ED (2101 or 55.2% of all referrals), most patients were admitted and 343 (16% of those referred to the ED) were discharged home. Conclusions The direct admission process helped avoid ED assessments for some patients; however, some patients referred to the ED were able to be evaluated, treated, and discharged. Consistent triage of the patients being transferred as direct admissions may improve ED throughput and potentially improve the patient's experience, reduce redundant services, and expedite care.

Pediatric ED Saves: Analyzing the ED Screen of Direct Admissions

“…Occasionally, patients planned as DAs may be more ill on arrival than the inpatient floor can manage, requiring immediate intervention and even intensive care unit (ICU) admission. 1–3 Despite this, few guidelines exist to mitigate adverse events for these patients. 1,2…”

“…[1][2][3] Despite this, few guidelines exist to mitigate adverse events for these patients. 1,2 Although various scoring systems have assessed patients arriving at an ED, there is a lack of guidelines to help physicians assess pediatric patients that do not enter the hospital through the ED yet may be too ill for DA. 2,[4][5][6][7][8][9] To maximize the safety of patients presenting as DAs, our institution developed a process to screen patients in the ED to prevent critically ill patients from arriving on the inpatient floor.…”

“…1,2 Although various scoring systems have assessed patients arriving at an ED, there is a lack of guidelines to help physicians assess pediatric patients that do not enter the hospital through the ED yet may be too ill for DA. 2,[4][5][6][7][8][9] To maximize the safety of patients presenting as DAs, our institution developed a process to screen patients in the ED to prevent critically ill patients from arriving on the inpatient floor. Upon arrival at our institution, a pediatric emergency medicine (PEM) attending/fellow and ED nurse evaluate patients using the screening process.…”

“…Although various scoring systems have assessed patients arriving at an ED, there is a lack of guidelines to help physicians assess pediatric patients that do not enter the hospital through the ED yet may be too ill for DA. 2,4–9…”

“…Occasionally, patients planned as DAs may be more ill on arrival than the inpatient floor can manage, requiring immediate intervention and even intensive care unit (ICU) admission. [1][2][3] Despite this, few guidelines exist to mitigate adverse events for these patients. 1,2 Although various scoring systems have assessed patients arriving at an ED, there is a lack of guidelines to help physicians assess pediatric patients that do not enter the hospital through the ED yet may be too ill for DA.…”