Journal article
Inappropriate referrals in pediatric surgery
Journal of pediatric surgery, Vol.55(12), pp.2596-2601
12/01/2020
DOI: 10.1016/j.jpedsurg.2020.06.012
PMID: 32660777
Abstract
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.
Details
- Title: Subtitle
- Inappropriate referrals in pediatric surgery
- Creators
- Laura A. Shinkunas - University of IowaCaleb J. Klipowicz - University of IowaErica M. Carlisle - University of Iowa Hospitals and Clinics
- Resource Type
- Journal article
- Publication Details
- Journal of pediatric surgery, Vol.55(12), pp.2596-2601
- Publisher
- Elsevier
- DOI
- 10.1016/j.jpedsurg.2020.06.012
- PMID
- 32660777
- ISSN
- 0022-3468
- eISSN
- 1531-5037
- Number of pages
- 6
- Language
- English
- Date published
- 12/01/2020
- Academic Unit
- Medical Ethics; Stead Family Department of Pediatrics; Surgery
- Record Identifier
- 9984322795402771
Metrics
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