title: Referral of nonurgent children from the emergency department to general practice:  compliance and cost savings.
abstract: OBJECTIVE
  To evaluate compliance and costs of referral of nonurgent children, who present at the emergency department, to the general practitioner cooperative (GPC).
  
  
  METHODS
  In a prospective observational before-after study, during 6 months in 2008, the triage nurse discussed referral to the GPC with parents, when self-referred children with a nontraumatic problem, aged 3 months-16 years were triaged as nonurgent (levels 4 and 5) according to the Manchester Triage System. A telephone follow-up was performed 2-4 days after referral. Real costs were calculated for emergency department consultation (preintervention period) and GPC referral (postintervention period). Compliance of referral was studied for 4 days a week.
  
  
  RESULTS
  One hundred and forty patients were referred to the GPC, of which 101 out of 140 patients (72%) attended a follow-up. After discharge seven patients (7%) had an unscheduled revisit. No patients were subsequently hospitalized. In total 275 patients were included to study compliance, with 28 (10%) reported missing. Ninety-five out of 247 (38%) patients were referred to the general practitioner and 46 out of 247 parents (19%) refused referral. For 106 out of 247 patients (43%) referral was not initiated by the nurse mainly because of comorbidity. Mean costs per patient were €106 for the preintervention period and €101 for the postintervention period.
  
  
  CONCLUSIONS
  Compliance of referring low urgent patients is low, mainly because it was difficult for nursing staff to refer. Total overall cost benefit is minimal. Cost savings may be achieved in different settings, where general practitioner services are colocated and where large numbers can be referred.
authors.affiliation: Department of Paediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Mirjam
authors.initials: M
authors.lastname: van Veen
authors.forename: Frank
authors.initials: F
authors.lastname: ten Wolde
authors.forename: Marten J
authors.initials: MJ
authors.lastname: Poley
authors.forename: Madelon
authors.initials: M
authors.lastname: Ruige
authors.forename: Alfred H J
authors.initials: AH
authors.lastname: van Meurs
authors.forename: Cato
authors.initials: C
authors.lastname: Hablé
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
authors.forename: Henriëtte A
authors.initials: HA
authors.lastname: Moll
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D058005:General Practitioners / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D009426:Netherlands; D009741:Nursing Staff, Hospital; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012017:Referral and Consultation / Q000191:economics* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014218:Triage / Q000379:methods