Referrals to a pediatric emergency room of a tertiary care teaching hospital before and after introduction of a referral education module- a qualitative study 

Abstract

Background: Provision of timely care to critically ill children is essential for good outcome. With development of specialized pediatric critical care units, referral from community and smaller peripheral hospitals has received greater impetus. Our tertiary care hospital caters to referrals from a wide geographical area. Since there is no standard referral and feedback system in India, we decided to evaluate the quality of referrals coming to our Emergency Room (ER) with respect to their demography, association with severity of illness and mortality. We plan to use this data to establish a standard referral and feedback process to streamline our ER referrals. Methods: Our study was completed in three phases in Pediatric ER;Pre-intervention, Intervention and Post intervention phases. Quality of referrals was graded by granting one score to presence of each item when matched with a quality checklist performa. A referral was graded ‘good’, ‘fair’ and ‘poor’ if it scored >7, 5 –7 and < 5 points respectively. Case studies, expert opinions, and lacunae observed in first phase were taken into consideration while preparing the referral education module, that was administered to health care providers of referring hospitals. Quality of referrals was compared between pre and post intervention phases. Results: Majority of inpatient admissions were ‘referred’ patients (99.3%). Most referrals belonged to the neighboring states of Punjab (48.2%) and Haryana (22.4%). Major referrals were from public sector hospitals (80.9%) of which the teaching hospitals topped the list (53.6%). Most common mode of transport was government run ambulance services(85.5%) and the common reason for referral was need for PICU bed and/or mechanical ventilation (50.4%). The post intervention phase saw a significant decline in the proportion of poor referrals (93.2 vs.78.2%;p=0.001) and a significant increase in the proportion of fair(6.1 vs 18%; p=0.001)and good referrals (0.7 vs 18%;p=0.001) Proportion of children presenting to triage with physiological decompensation with respect to poor referrals had significantly decreased in post intervention phase [580(79.8%) vs 1025(93.7%); p=0.0001]. Conclusion:Referral education had significantly improved the quality of referrals coming to our ER. Continuing education will be required for sustained and increased benefits. Key words: Quality of referral, Pediatric emergency, Triage

Adherence to National Healthcare Referral Guidelines and Its Effect on the Management Outcomes Among Children Seen at a Teaching Hospital in Western Kenya

“…This disparity could be attributed to poor communication channels between the referring and receiving facilities in Kenya. In Punjab-India [16], pre-referral documentation was also found to be inadequate and lower than those reported here at 3.7%. The proportions of children who were transferred by an ambulance (64.2%) and those who were accompanied (68.7%) was close to those reported in Vietnam [4] at 57.8% and 49.6% respectively.…”

“…The proportions of children who were transferred by an ambulance (64.2%) and those who were accompanied (68.7%) was close to those reported in Vietnam [4] at 57.8% and 49.6% respectively. Higher government ambulance transfer rate of 85.5% from public hospitals was reported in India [16]. Furthermore, in this study, 87% of the children transferred in an ambulance were accompanied by a nurse compared to 25.1% in Vietnam [4].…”