Redirecting Nonurgent Patients From the Pediatric Emergency Department to Their Pediatrician Office for a Same-Day Visit—A Quality Improvement Initiative

Abstract

Objectives: Providing high-quality care in the appropriate setting to optimize value is a worthy goal of an efficient health system. Consequences of managing nonurgent complaints in the emergency department (ED) have been described including inefficiency, loss of the primary care-patient relationship, and delayed care for other ED patients. The purpose of this initiative was to redirect nonurgent patients arriving in the ED to their primary care office for a same-day visit, and the SMARTAIM was to increase redirected patients from 0% of those eligible to 30% in a 12-month period. Methods:The setting was a pediatric ED (PED) and primary care office of a tertiary care pediatric medical system. The initiative utilized the electronic health record to identify and mediate the redirection of patients to the patient's primary care office after ED triage. The primary measurement was the percentage of eligible patients redirected. Additional measures included health benefits during the primary care visit (vaccines, well-visits) and a balancing measure of patients returned to the PED. Results:The SMART AIM of >30% redirection was achieved and sustained with a final redirection rate of 46%. In total, 216 of 518 eligible patients were redirected, with zero untoward outcomes. The encounter time for redirected patients was similar for those who remained in the PED, and additional health benefits were appreciated for redirected patients.Conclusions: This initiative redirected nonurgent patients efficiently from a PED setting to their primary care office. The process is beneficial to patients and families and supports the patient-centered medical home. The balancing measure of no harm done to patients who accepted redirect reinforced the reliability of PED triage. The benefits achieved through the project highlight the value of the primary care-patient relationship and the continued need to improve access for patients and families.

Standardizing Child Passenger Safety Screening in the Emergency Department: A Quality Improvement Study

“…The QI project was implemented in a pediatric ED that serves as primary and urgent care for many families. Recent studies have identified this common pattern of pediatric ED use for nonurgent conditions (Frazier et al, 2022;Li et al, 2022;Wolski et al, 2022). The ED represents a prime opportunity to screen families for CPS needs, as they may not receive important anticipatory guidance surrounding injury prevention education in the primary care setting.…”

Alternative care sites and resident exposure in pediatric emergency medicine: Who, what, and where

“…In addition to the increasing number of behavioral health boarders, pediatric EDs have faced fluctuations in patient volumes due to the SARS‐CoV‐19 pandemic and novel bacterial and viral transmission patterns 16,31–33 . To address these recent trends, new clinical care models have been developed including alternative care sites 13,18,19,34 . To date, no studies have examined the impact that these trends and resulting changes in clinical operations have on patient exposure during residency training.…”

“…16,[31][32][33] To address these recent trends, new clinical care models have been developed including alternative care sites. 13,18,19,34 To date, no studies have examined the impact that these trends and resulting changes in clinical operations have on patient exposure during residency training. While there is no ability to ensure clinical exposure translates to competency, clinical care is a core part of training.…”

“…These include increasing primary care utilization, transferring care for boarding patients to inpatient teams, increasing the care provided in triage, and creating alternative care sites for seeing patients. [18][19][20][21] Alternative care sites are spaces temporarily converted for health care delivery to provide additional capacity and capability. 22 In the case of the ED, alterative care site refers to a space converted for clinical use outside of the main ED where care is provided by the ED staff.…”

“…While patient volumes and mix do not change abruptly, they eventually reach a threshold that prompts pediatric EDs to innovate clinical operations models in response. These include increasing primary care utilization, transferring care for boarding patients to inpatient teams, increasing the care provided in triage, and creating alternative care sites for seeing patients 18–21 . Alternative care sites are spaces temporarily converted for health care delivery to provide additional capacity and capability 22 .…”