Unnecessary Urgent Care to Emergency Transfers

August 9, 2018

Written by Clay Smith

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In this single center, 27% of urgent care (UC) to pediatric emergency department (PED) transfers were likely unnecessary and resulted in discharge with no ED resource utilization.

Why does this matter?
Referral to the ED means time and money to families.  Unnecessary referral to the ED means wasted time and money.  Also, in an era of ED overcrowding, unnecessary referrals contribute to higher ED volume.

They don’t all need to come to the PED
This was a retrospective chart review of patients transferred to a PED from UC.  They found that 27% (29/109) of all UC referrals to the PED were discharged with no PED resource utilization.  This suggests that these transfers may not have been necessary.  Overall, 85% of all UC to PED transfers were discharged home.  There are several limitations.  Perhaps the condition of the patient markedly improved by the time they arrived in the ED.  This can certainly happen.  Maybe the UC felt the child needed a longer period of observation.  Or maybe the UC got an incomplete history that was further clarified by family in the PED that allowed for safe discharge.  Maybe the PED should have done more for the patients who were sent, were wrong to discharge them, and patients went to another ED outside that hospital system when they worsened.  There are many legitimate reasons for seemingly unnecessary transfers.  And it’s easy to play “armchair quarterback.”  But this study, which fits with my experience, suggests that many UC to PED (or ED) transfers could be avoided.

Source
Urgent Care Transfers to an Academic Pediatric Emergency Department.  Pediatr Emerg Care. 2018 Mar;34(3):185-188. doi: 10.1097/PEC.0000000000001297.
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Reviewed by Thomas Davis