Transition of Care: Pediatric Ambulatory Center to Emergency Department.

Abstract

Little is known about the characteristics, clinical course, and the disposition of sick children transferred from pediatricians' offices to the emergency department (ED). The purpose of the study was to determine the clinical profile, ED course, and disposition of children transferred from a hospital-based pediatric clinic to the ED. We conducted a retrospective cohort study involving all sick children transferred from a hospital-based clinic to the hospital's ED from January 2012 to December 2013. Data collected included demographics, acuity of illness, ED course, diagnoses, and disposition of all children. A total of 179 patients were transferred to and received care in the ED: boys, 56%; median age, 18 months; mean age, 58 months; 68% were younger than 60 months; African American, 83%; Hispanic, 12%. Sixty-eight percent of the patients were triaged as Emergency Severity Index 3 (urgent) and 13% were Emergency Severity Index 2 (high risk), with the rest categorized as nonurgent. Forty-three percent (78) were discharged home, and 57% were admitted. Age younger than 60 months, need for intravenous antibiotics, inhaled medications, plain x-rays, respiratory viral panel polymerase chain reaction (PCR), supplemental oxygen, and blood work in the ED were associated with being admitted (P < 0.05). The top 3 primary diagnoses were respiratory distress (40%), skin and soft tissue infections (15%), and other infections (10%). Children transferred from a hospital-based pediatric clinic to the ED at an urban academic medical center had a high level of acuity, and almost 60% were admitted for inpatient care. Improvement in the provision of pretransfer care can potentially decrease transfers to the ED.