title: Outcomes From Referrals and Unscheduled Visits From Community Emergency Departments to a Regional Pediatric Emergency Department in Canada.
abstract: OBJECTIVE
  Existing pediatric literature describing repeat visits to the emergency department (ED) for the same medical complaint has yet to report on patient flow patterns from general EDs (GEDs) to a pediatric ED (PED). We sought to characterize the population of patients who are treated in a GED and subsequently present to a PED for further care.
  
  
  METHODS
  We conducted a retrospective cohort study reviewing all pediatric visits (age < 17 y) at 5 GEDs in Vancouver. Our primary outcome measure was the proportion of visits with a subsequent visit to a PED (<7 days) during the 2012 to 2013 fiscal year. Secondary outcomes included reasons for PED consultation, the clinical services accessed, and disposition at the PED.
  
  
  RESULTS
  During the study period, 581 (3.3%) of the 17,824 children seen at GEDs subsequently presented to the PED within 7 days. The top 3 diagnoses among these were fracture, viral infection, and musculoskeletal complaints. Of the 581 children with a visit to the PED, 180 (31.0%) were referred to the PED for a consultation, whereas the rest were family initiated. Referred visits were more frequently associated with pediatric subspecialist consultation than family-initiated visits (45.0% vs 19.5%, P < 0.01). The referred group more frequently resulted in a surgical procedure (13.9% vs 2.5%, P < 0.01) or hospital admission (51.7% vs 8.7%, P < 0.01).
  
  
  CONCLUSIONS
  Knowing the proportion, management, and outcomes of children who are treated in a GED and subsequently at a PED may provide an important quality measure and opportunities to improve the management of common pediatric emergencies in the community.
authors.forename: Ethan
authors.initials: E
authors.lastname: Reiner
authors.affiliation: Department of Pediatrics, Children's Hospital of British Columbia.
authors.forename: Ardalan
authors.initials: A
authors.lastname: Ahmadi
authors.affiliation: Department of Emergency Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Grafstein
authors.affiliation: Department of Pediatrics, Children's Hospital of British Columbia.
authors.forename: Quynh
authors.initials: Q
authors.lastname: Doan
mesh_terms: D000293:Adolescent; D002170:Canada; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003153:Community Health Services / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies