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The appropriateness of referrals to a pediatric emergency department via a telephone health line

Published online by Cambridge University Press:  21 May 2015

Tawfik Al-Abdullah ,
Amy C. Plint ,
Alyson Shaw ,
Rhonda Correll ,
Isabelle Gaboury ,
Carrol Pitters ,
Anna Bottaglia  and
Tammy Clifford
Tawfik Al-Abdullah
Affiliation:
Emergency Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
Amy C. Plint*
Affiliation:
Department of Pediatrics, Department of Emergency Medicine, University of Ottawa, Ottawa, Ont. Department of Emergency Medicine, University of Ottawa, Ottawa, Ont. Division of Emergency Medicine, Children’s Hospital of Eastern Ontario, Ottawa, Ont.
Alyson Shaw
Affiliation:
Department of Pediatrics, Department of Emergency Medicine, University of Ottawa, Ottawa, Ont.
Rhonda Correll
Affiliation:
Division of Emergency Medicine, Children’s Hospital of Eastern Ontario, Ottawa, Ont.
Isabelle Gaboury
Affiliation:
Chalmers Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ont.
Carrol Pitters
Affiliation:
Department of Pediatrics, Department of Emergency Medicine, University of Ottawa, Ottawa, Ont. Department of Emergency Medicine, University of Ottawa, Ottawa, Ont. Division of Emergency Medicine, Children’s Hospital of Eastern Ontario, Ottawa, Ont.
Anna Bottaglia
Affiliation:
Canadian Forces Health Services Centre, Ottawa, Ont.
Tammy Clifford
Affiliation:
Department of Pediatrics, Department of Emergency Medicine, University of Ottawa, Ottawa, Ont. Canadian Agency for Drugs and Technologies in Health, Ottawa, Ont. Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ont.
*
Children’s Hospital of Eastern Ontario, 401 Smyth Ave., Ottawa ON K1H 8L1; plint@cheo.on.ca

Abstract

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Objective:

We compared the appropriateness of visits to a pediatric emergency department (ED) by provincial telephone health line–referral, by self- or parent-referral, and by physician-referral.

Methods:

A cohort of patients younger than 18 years of age who presented to a pediatric ED during any of four 1-week study periods were prospectively enrolled. The cohort consisted of all patients who were referred to the ED by a provincial telephone health line or by a physician. For each patient referred by the health line, the next patient who was self- or parent-referred was also enrolled. The primary outcome was visit appropriateness, which was determined using previously published explicit criteria. Secondary outcomes included the treating physician's view of appropriateness, disposition (hospital admission or discharge), treatment, investigations and the length of stay in the ED.

Results:

Of the 578 patients who were enrolled, 129 were referred from the health line, 102 were either self- or parent-referred, and 347 were physician-referred. Groups were similar at baseline for sex, but health line–referred patients were significantly younger. Using explicitly set criteria, there was no significant difference in visit appropriateness among the health line–referrals (66%), the self- or parent-referrals (77%) and the physician-referrals (73%) (p = 0.11). However, when the examining physician determined visit appropriateness, physician-referred patients (80%) were deemed appropriate significantly more often than those referred by the health line (56%, p < 0.001) or by self- or parent-referral (63%, p = 0.002). There was no significant difference between these latter 2 referral routes (p = 0.50). In keeping with their greater acuity, physician-referred patients were significantly more likely to have investigations, receive some treatment, be admitted to hospital and have longer lengths of stay. Patients who were self- or parent-referred, and those who were health line–referred were similar to each other in these outcomes.

Conclusion:

There was no significant difference in visit appropriateness based on the route of referral when we used set criteria; however, there was when we used treating physician opinion, triage category and resource use.

Keywords

childrenemergencyappropriateness
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 11 , Issue 2 , March 2009 , pp. 139 - 148
Copyright
Copyright © Canadian Association of Emergency Physicians 2009

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