Transitions of Care

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.

Pediatric Critical Care Transport

“…Genovesi et al 24 reported an increase in the presence of written interfacility guidelines and use of agreements but almost a third of the hospitals in this study do not have any. The literature describes that in hospitals with low and medium ED patient volumes were often lacking of written interfacility transfer guidelines and/or agreements, and in our survey, there is a lack of protocols and regulatory laws.…”

Pediatric Readiness in Critical Access Hospital Emergency Departments

“…Considering a majority of CAHs in the study are challenged to have necessary resources to sustain care for ill or injured children, having processes in place to transfer a child to the appropriate level of care is essential. 12,32,33 This element of pediatric readiness is an administrative element that potentially has minimal financial burden on a facility. Models of agreements and guidelines exist, as well as models in Arizona that demonstrate their presence can decrease mortality among severely injured children.…”

Characteristics Associated With Presence of Pediatric Mental Health Care Policies in Emergency Departments

“…Prior analyses of NPRP data demonstrated the importance of pediatric emergency care coordinators (PECCs) on overall pediatric readiness, as well as regional differences in pediatric readiness. [19][20][21][22] However, demographic and hospital characteristics of EDs with pediatric mental health care policies, as well as In line with previous findings showing that rural areas had lower levels of pediatric readiness compared with urban areas, 19 we hypothesized that rural counties would have fewer EDs with a pediatric mental health care policy in place. We also hypothesized that among EDs having PECCs and additional policies in place aimed at addressing children's mental health care needs, including reporting and treating suspected child abuse and neglect, policies for promoting family-centered care, and written guidelines for transfer of children with mental health concerns, would be associated with having a mental health care policy.…”