396 - Does Handoff Communication from Primary Care Providers Affect Outcomes in the Pediatric Emergency Department?

Poster Number: 396
Publication Number: 396.315

Bradley Beamon, University of Mississippi Medical Center, Brandon, MS, United States; Justin R. Davis, University of Mississippi Medical Center, Spring, TX, United States; John Heard, UMMC, Jackson, MS, United States; Austin N. Southern, University of Mississippi School of Medicine, Jackson, MS, United States; Stacey Ferguson, University of Mississippi Medical Center, Jackson, MS, United States

Background: When children are referred to the Pediatric Emergency Department (PED) by their Primary Care Provider (PCP), provider surveys previously found that handoff communication was rarely ‘very good’ or ‘excellent’. Providers believed that improved interfacility communication would result in improved efficiency, patient satisfaction, and PCP follow-up.

Objective: We sought to determine if the presence of communication between the PCP and PED, among children referred to the PED, was associated with differences in triage acuity, PED Length of Stay (LOS), PED consultations, referrals, hospitalization rates, PCP follow up rates, PED return visits, and parent satisfaction.

Design/Methods: Children ages 0-17 who presented to a single tertiary-care PED from 01/2021 to 10/2021 as a referral from their PCP were eligible for inclusion in this prospective observational study. Referrals without communication between the PCP and PED were compared to referrals with communication via the institution’s transfer center. Transfer center referrals were also subdivided based on whether a verbal physician-to-physician handoff occurred. Outcomes obtained via chart review included: triage acuity, LOS, consultations, referrals, hospitalization, and PED return visits. Outcomes obtained via a parent survey 4 weeks after the PED visit included: PCP follow up and parent satisfaction.

Results: We enrolled 343 children and 293 (85%) parents completed the follow up survey. There were 136 (46%) children with no communication, 74 (25%) with transfer center communication only, and 83 (28%) with transfer center communication plus a verbal handoff [Table 1]. Children with transfer center communication only (49/74, 66%) and verbal handoffs (44/83, 53%) were more frequently hospitalized versus those with no communication (58/136, 43%, p< 0.001). There was no significant difference between the groups in triage acuity, LOS, consultations, referrals, PCP follow-up, PED return visits, or parent satisfaction [Table 2]. Parents who were aware that communication occurred were more often 'very satisfied' (138/184, 75%) versus those who were not aware (69/109, 63%, p=0.03) [Table 3].Conclusion(s): When children were referred to the PED by their PCP, handoff communication was associated with a higher rate of hospitalization. No differences were observed in other clinical outcomes. However, parents who were aware that communication occurred were more frequently ‘very satisfied’ with their PED visit. Parental perception regarding handoff communication may be a good target for quality improvement and future studies.
Beamon CVBeamon CV2021.pdf
Table 2Table 2.jpegOutcomes, Pediatrician to Pediatric Emergency Department Referrals, by Communication Type