Emergency & Trauma

September 1, 2022

New protocol moves pediatric ED patients to primary care clinic

Vanderbilt has created a pediatric emergency department to primary care clinic transfer protocol as an alternative for using the ED for non-urgent conditions that can be treated in a primary care setting.


by Jessica Pasley

For the past two decades, hospitals have seen an uptick in the number of patients using emergency departments for non-urgent care. This practice has led to overcrowding and longer wait times.

It’s an issue that a team at Monroe Carell Jr. Children’s Hospital at Vanderbilt wanted to reconcile.

“Nationwide, there have been studies showing that 90% of academic emergency departments experience this phenomenon,” said Barron Frazier, MD, assistant professor of Clinical Pediatrics and Emergency Medicine. “This is compounded by an estimated 2 million children using EDs as a source of routine sick care. Up to 50% of non-urgent complaints land in pediatric emergency departments.

“As health care systems grow and become more complex, families are asking where they need to go to get the appropriate medical care for their children,” he said. “We were able to challenge the status quo and rethink urgent care and the processes.”

Frazier and his team created an emergency department to primary care clinic transfer protocol as an alternative for using the ED for non-urgent conditions that can be treated in a primary care setting.

The findings from the implementation were recently released in Healthcare: The Journal of Delivery Science and Innovation. The study analyzed the impact the protocol had on patient encounters.

In 2017, the team began checking the electronic medical records as patients were being triaged in the ED for low acuity visits between 8 a.m. and 4 p.m. (during the primary care clinic’s operating hours).

If documented as an established patient, the family was asked if they would like to see a pediatrician in the 8th floor primary care clinic, six floors above.

Most agreed.

According to the study, the protocol provided a safe and efficient method for patients to be evaluated in their medical homes.

During a one-year period, from September 2017 to August 2018, there were 401 patient encounters considered for transfer with 374 patient encounters (93.3%) transferred from the ED to the primary care clinic.

Moving to the pediatric clinic had several advantages, said Frazier, including reducing costs, decreasing length of visit and creating opportunities for additional primary care services to be provided.

“The primary care interactions not only encouraged appropriate level of care, but it also allowed the primary care physician to reconnect with the patient and family,” said Frazier. “These encounters allowed for re-evaluation of chronic conditions, medication refills, developmental screenings, vaccinations and aided in additional diagnoses and referrals for other health concerns.

“Not only was it more timely care, but it was more well-rounded care.”

Overall, the study showed about $100,000 cost savings during that period (costs were reduced to $29-$49 for every $100 spent in the ED). For the top 10 diagnoses, the length of stay was reduced by a mean of 49 minutes per encounter.

“Our biggest takeaway for clinicians — how can we reinvent access or entry into health care?” said Frazier. “We have to take the onus off of families and develop a better system to guide families to the right setting for the right care for their children.”

Frazier, the first author of the report, hopes to restart the protocol, which was halted during the COVID pandemic, to best meet the needs of all children who seek medical attention.