Pediatric Referrals to an Emergency Department From Urgent Care Centers

Olympia, Robert P.; Wilkinson, Robert; Dunnick, Jennifer; Dougherty, Brendan J.; Zauner, Debra

doi:10.1097/pec.0000000000000955

Cited by 11 publications

(15 citation statements)

References 27 publications

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“…For pediatric population, abdominal pain is a common complaint in the emergency department (ED) (1). Abdominal pain was reported up to 6.2% of all pediatric emergency admissions (2).…”

Section: Introductionmentioning

confidence: 99%

Investigation of the Diagnostic Value of Neutrophil to Lymphocyte Ratio in Pediatric Appendicitis Cases

Yılmaz

Acar

2017

Iran J Pediatr

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“…For pediatric population, abdominal pain is a common complaint in the emergency department (ED) (1). Abdominal pain was reported up to 6.2% of all pediatric emergency admissions (2).…”

Section: Introductionmentioning

confidence: 99%

Investigation of the Diagnostic Value of Neutrophil to Lymphocyte Ratio in Pediatric Appendicitis Cases

Yılmaz

Acar

2017

Iran J Pediatr

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“…This contrasts with previously published data showing high rates of inappropriate pediatric transfer to EDs from general UCCs. In their study of general UCC ED referrals, Olympia et al 9 concluded that 24% (108/455) of pediatric referrals were “nonessential,” defined as not requiring diagnostic/radiologic investigations, procedure sedation, laceration repair, reduction/casting/splinting, subspecialty consultation, or hospitalization. Furthermore, McCarthy et al 8 determined that 27% (29/109) of transferred children in their study did not require ED resource utilization, defined as any ED intervention other than the administration of oral prescription or nonprescription medication or performance of a throat culture or pregnancy test.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 Pediatric patients seen in general UCCs have an even higher rate of ED transfer for minor injuries than adults. 8,9 Pediatric UCCs are typically staffed with pediatricians and advanced practice providers (APPs) who have pediatric-specific training. This clinician training may make PUC management and disposition of common, minor pediatric trauma, an area which has not previously been studied, distinct from general UCCs.…”

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confidence: 99%

Pediatric Urgent Care Center Management of Traumatic Injuries in Infants and Children

et al. 2022

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Objectives: To determine pediatric urgent care (PUC) clinician adherence to evidence-based practice guidelines in the management of pediatric trauma and to evaluate PUC emergency preparedness for conditions such as severe hemorrhage.Methods: A questionnaire covering acute management of 15 pediatric traumatic injuries, awareness of the Stop the Bleed initiative, and presence of emergency equipment and medications was electronically distributed to members of the Society for Pediatric Urgent Care. Clinician management decisions were evaluated against evidence-based practice guidelines.Results: Eighty-three completed questionnaires were returned (25% response rate). Fifty-three physician and 25 advanced practice provider (APP) questionnaires were analyzed. Most respondents were adherent to evidence-based practice guidelines in the following scenarios: cervical spine injury; head injury without neurologic symptoms; blunt abdominal injury; laceration without bleeding, foreign body, or signs of infection; first-degree burn; second-degree burn with less than 10% total body surface area; animal bite with and without probable tenosynovitis; and orthopedic fractures. Fever respondents were adherent in the following scenarios: head injury with altered mental status (adherence: physicians, 64%; APPs, 44%) and laceration with foreign body and persistent hemorrhage (adherence: physicians, 52%; APPs, 41%). Most respondents (56%) were unaware of Stop the Bleed and only 48% reported having a bleeding control kit/tourniquet at their urgent care.Conclusions: Providers in our sample demonstrated adherence with pediatric trauma evidence-based practice guidelines. Increased PUC provider trauma care certification, PUC incorporation of Stop the Bleed education, and PUC presence of equipment and medications would further improve emergency preparedness.

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“…Representative quotes provide explanation for their lack of experience. procedures education during pediatric residency are all existing barriers to GPeds performing these procedures in their current practice [35,36]. With this in mind, perhaps GPeds do not need to become proficient in all of these procedures during residency training.…”

Section: Discussionmentioning

confidence: 99%

How general pediatricians learn procedures: implications for training and practice

Iyer

Way

Schumacher

et al. 2021

Medical Education Online

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The Accreditation Council for Graduate Medical Education (ACGME) requires General Pediatricians (GPeds) to learn thirteen procedures during training. However, GPeds infrequently perform these procedures in practice. We sought to determine:1) how GPeds learned procedures, 2) if GPeds self-reported achieving competence in the required ACGME procedures during training, and 3) if GPeds maintained these skills into practice. We conducted this mixed methods study from 2019-2020. 51 GPeds from central Ohio and the American Board of Pediatrics General Examination Committee were recruited via email or snowball sampling and participated in semi-structured recorded phone interviews probing procedural performance during training and current practice. Participants represented varied geographic regions and clinical settings. We employed Sawyer's 'Learn, See, Practice, Prove, Do, Maintain' mastery learning pedagogical framework as a lens for thematic analysis. Participants did not demonstrate competence in all ACGME required procedures during training, nor sustain procedural skills in practice. Most participants learned procedures through a 'see one, do one' apprenticeship model. GPeds reported never being formally assessed on procedural competence during residency. All GPeds referred out at least one procedure. GPeds also believed that skill maintenance was unwarranted for procedures irrelevant to their current practice. GPeds did not sufficiently demonstrate competence in all ACGME required procedures during training, partially suggesting why they infrequently perform some procedures. Alternatively, these required procedures may not be relevant to their practice. Pediatric residency procedures education might consider using mastery learning for practice-specific procedures and surface-level methods (learning without mastery) for other skills.

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Pediatric Referrals to an Emergency Department From Urgent Care Centers

Abstract: Many ED referrals directed from urgent care centers in our sample were considered essential, and few were considered serious. Urgent care centers should develop educational and preparedness strategies based on the epidemiology of emergencies that may occur.

Cited by 11 publications

References 27 publications

Investigation of the Diagnostic Value of Neutrophil to Lymphocyte Ratio in Pediatric Appendicitis Cases

Investigation of the Diagnostic Value of Neutrophil to Lymphocyte Ratio in Pediatric Appendicitis Cases

Pediatric Urgent Care Center Management of Traumatic Injuries in Infants and Children

How general pediatricians learn procedures: implications for training and practice

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