title: Before the Flood: Impact of Coordination of Care and Direct Admissions on Emergency Department Volumes.
abstract: BACKGROUND
  Transfers of pediatric patients occur to access specialty and subspecialty care, but incur risk, and consume resources. Direct admissions to medical and surgical wards may improve patient experience and mitigate resource utilization.
  
  
  OBJECTIVE
  We sought to identify common elements for direct admissions, as well as the pattern of disposition for patients referred to our emergency department (ED).
  
  
  METHODS
  A retrospective qualitative analysis of patients transferred to our pediatric hospital for 12 months was performed. Different physician groups were evaluated for use of direct admissions or evaluation in the ED. Patients referred to the ED were additionally tracked to evaluate their eventual disposition.
  
  
  RESULTS
  A total of 3982 transfers occurred during the 12-month analysis period. Of those, 3463 resulted in admission, accounting for 32.55% of all admissions. Transfers accepted by nonsurgical services accounted for 82% of the transfers, whereas 18% were facilitated by one of the surgical services. Direct admissions accounted for 1707 (44.8%) of all referrals and were used more often by nonsurgical services. Of patients referred to the ED (2101 or 55.2% of all referrals), most patients were admitted and 343 (16% of those referred to the ED) were discharged home.
  
  
  CONCLUSIONS
  The direct admission process helped avoid ED assessments for some patients; however, some patients referred to the ED were able to be evaluated, treated, and discharged. Consistent triage of the patients being transferred as direct admissions may improve ED throughput and potentially improve the patient's experience, reduce redundant services, and expedite care.
authors.forename: Emily C
authors.initials: EC
authors.lastname: Webber
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Bauer
authors.forename: Chrissy K
authors.initials: CK
authors.lastname: Marcum
authors.forename: Mara E
authors.initials: ME
authors.lastname: Nitu
authors.forename: Jennifer D
authors.initials: JD
authors.lastname: Walthall
authors.forename: Michele S
authors.initials: MS
authors.lastname: Saysana
mesh_terms: D002648:Child; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D036301:Qualitative Research; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014218:Triage / Q000379:methods