Inappropriate referrals in pediatric surgery
Inappropriate referrals in pediatric surgery
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DOI：
10.1016/j.jpedsurg.2020.06.012
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发表时间：
2020-12-01
影响因子：
2.4
通讯作者：
Carlisle, Erica M.
中科院分区：
文献类型：
--
作者：
Shinkunas, Laura A.;Klipowicz, Caleb J.;Carlisle, Erica M.
背景：不适当的转诊消耗了大量的卫生系统资源。为了优化转诊模式，美国儿科学会等组织提供了关于适当手术转诊的政策声明。在这里，我们确定不适当的转介到pediatric surgery.Methods：回顾性图表审查的新患者在儿科外科诊所在一所大学的基础上，三级保健儿童医院超过12个月。人口统计学，保险，转介供应商/外科医生的诊断，和转介供应商专业进行了抽象和编码为适当/inappropriate.Results：五百九转介确定; 19%是不适当的。与医生和儿科提供者相比，中级提供者（OR = 1.97，p = 0.02）和非儿科提供者（OR = 1.94，p = 0.01）的不适当转诊更常见。女性患者（OR = 1.65，p = 0.03）和年轻患者（OR = 0.94，p = 0.002）比老年男性患者更容易出现不适当的转诊。脐疝、胸壁畸形和胃肠道不适是不适当转诊患者最常见的诊断。不适当转诊患者的平均距离为57.8英里，农村（78英里;范围= 12-199）和城市（42英里;范围= 0-125）患者的平均距离有显著差异（p < 0.01）。结论：尽管有适当转诊模式的指南，19%的儿科手术转诊是不适当的。加强对中级供应商的监督，儿科培训，或在手术咨询前转诊给当地儿科医生，可能会降低不适当转诊的发生率。(c)2020爱思唯尔公司All rights reserved.
Background: Inappropriate referrals consume a significant amount of health-system resources. To optimize referral patterns, organizations such as the American Academy of Pediatrics provide policy statements regarding appropriate surgical referrals. Here, we identify the volume/characteristics of inappropriate referrals to pediatric surgeons.Methods: Retrospective chart review of new patients evaluated in the Pediatric Surgery Clinic at a university based, tertiary-care Children's Hospital over 12-months. Demographics, insurance, referring provider/surgeon diagnosis, and referring provider specialty were abstracted and coded as appropriate/inappropriate.Results: Five hundred nine referrals were identified; 19% were inappropriate. Inappropriate referrals were more common from mid-level providers (OR = 1.97, p = 0.02) and non-pediatric providers (OR = 1.94, p = 0.01) compared to physicians and pediatric providers. Female patients (OR = 1.65, p = 0.03) and younger patients (OR = 0.94, p = 0.002) were more likely to have an inappropriate referral than their older, male peers. Umbilical hernia, chest wall deformity, and GI complaint were the diagnoses most frequently given to inappropriately referred patients. Average distance traveled by patients for an inappropriate referral was 57.8 miles with significant difference in average distance traveled for rural (78 miles; range = 12-199) and urban (42 miles; range = 0-125) patients (p < 0.01).Conclusions: Despite guidelines on appropriate referral patterns, 19% of pediatric surgery referrals are inappropriate. Increased supervision of mid-level providers, training in pediatrics, or referral to a local pediatrician prior to surgical consultation may decrease the rate of inappropriate referrals. (c) 2020 Elsevier Inc. All rights reserved.