Identifying problem areas and providing solutions to coordination of care in Urgent Care to Emergency Department transfers within a pediatric health care system




Severson, Samantha
Reed, Alexandra
Welch, JoAnn


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Purpose: Pediatric urgent care centers (UCCs) provide access to convenient, on demand medical care for patients who have non-emergent medical needs. Although, most patients who present to UCCs can be appropriately treated and discharged home, some patients present with medical needs outside the scope of practice for the UCC and are transferred to an emergency department (ED) for further evaluation. Currently, there are no established standards for such patients who need transfer of care from a pediatric UCC to an ED. This study examines the UCC to ED transfer process in an integrated pediatric health care system, identifies inefficiencies, and proposes a solution. Materials and Methods: The records of all patients transferred from a suburban UCC site to the urban, high volume ED between July 1, 2015 and May 16, 2016 were retrieved from the system’s transport department. Using retrospective chart review, UCC transfer diagnosis, ED discharge diagnosis, patient no shows, and those who left without being seen (LWBS). Results: Of the 245 transfers, 14 (6%) never arrived or LWBS and, 221 (96%) of these had non-missing values on the variables of interest. The ED provider noted in the ED record that the patient was a transfer from the system’s UCC in 167 (76%) cases. However, the review the UCC record was documented in only 58 (26%) cases. The patient was subsequently admitted to the ED in 51 (23%) cases. Using logistic regression, results showed that ED providers were more likely to review the UCC record when the chart stated that the patient was sent from the UCC (P Conclusions: This study revealed that in 1 out of 4 cases the ED providers were not aware that the patient was transferred from the UCC. Additionally, in 3 out of 4 known UCC transfers, the ED providers didn’t review the transfer records. These results demonstrate that the transfer of information from the UCC to ED during the transfer process has many opportunities for improvement. Based on these findings, a quality improvement initiative was implemented in November 2016: UCC providers now place bands on patients, who are to be transferred to the ED to signify to the ED staff that the patient was transferred. In summer 2017, transfer data based on this program will be compared to the results above to examine the efficacy of this initiative.