403 - Interfacility Referrals to a Tertiary Care Pediatric Emergency Department

Poster Number: 403
Publication Number: 403.315

Jason Todd, Medical College of Wisconsin, Milwaukee, WI, United States; Amy Drendel, Medical College of Wisconsin, Milwaukee, WI, United States; David Brousseau, Medical College of Wisconsin, Milwaukee, WI, United States; Amy R. Romashko, Children's Wisconsin, Milwaukee, WI, United States; Alexis Visotcky, Medical College of Wisconsin, Milwaukee, WI, United States; Raphael Fraser, Medical College of Wisconsin, Milwaukee, WI, United States; Mark Nimmer, Medical College of Wisconsin, Milwaukee, WI, United States

Background: Transfers to pediatric emergency departments (EDs) sometimes result in minimal resources utilized with no discernible improvement in outcomes, suggesting there may be an opportunity to optimize care delivery in the community. No study has evaluated the role of the outlying institution type, including EDs, urgent care centers (UCs), primary care pediatricians (PMDs), and subspecialists on ED resource utilization.

Objective: To characterize the pediatric patients referred to a tertiary care pediatric ED from all outlying institutions, and to describe the patients that utilized minimal resources in the ED.

Design/Methods: Retrospective cohort study of patients referred via phone conversation between an outlying institution provider and an ED physician who then had an ED visit during a 1-year period (2019). The primary outcome was minimal ED resource utilization, defined as: patients discharged home with no diagnostic testing, imaging, IV insertion/fluids, procedures, subspecialty consults, continuous monitors, or medications, excluding tests and interventions typically available in referring facilities (Strep or viral antigen swab, urine pregnancy test, urine point-of-care tests, antipyretics, PO antibiotics, and/or Ondansetron). Descriptive analyses and chi-squared tests were used.

Results: Of the 8,799 patients, 28% were referred from UCs, 23% from EDs, and 20% from both PMD offices and subspecialists. Overall, 11% met criteria for minimal ED resource utilization; these patients were younger (4.9 years vs 7.4 years; P < .001), more likely to be Latinx (18% vs 15%; P = .002) or Non-Hispanic Black (25% vs 21%; P = 0.006), and more likely to have respiratory (16% vs 12%; P < .001) or ENT (12% vs 7%; P < .001) diagnoses. One-half underwent only an ED assessment by a provider, and another 38% also received PO antibiotics, antipyretics, and/or Ondansetron. UCs (OR 2.08; CI 1.82,2.38) and PMD offices (OR 1.21; CI 1.03,1.41) had higher odds of referring a patient with minimal ED resource utilization.Conclusion(s): More patients were referred from UCs than EDs, PMD offices, or subspecialists. Both urgent care centers and PMD offices had higher odds of referring a patient with minimal ED resource utilization. Nearly 90% of children who met criteria for minimal ED resource utilization underwent only an ED assessment by a provider or an assessment and PO antibiotics, antipyretics, and/or Ondansetron. These findings may help to inform strategies for supporting and improving care at outlying institutions.