Transfers From a Pediatric Urgent Care to an Academic Pediatric Emergency Department.

OBJECTIVES: Patient transfers from outpatient urgent care centers are common occurrences in a pediatric emergency department (ED). A previous study done at our institution evaluated the clinical appropriateness of transfers from general urgent care centers into our pediatric ED, showing that a significant proportion (27%) of such transfers were discharged home with minimal ED resource utilization. This study investigated the hypothesis that transfers to a pediatric ED from a pediatric urgent care have higher rates of ED resource utilization when compared with patients transferred from general urgent care centers. METHODS: A retrospective chart review was completed during an 11-month period on all patients transferred from a pediatric urgent care center to the pediatric ED. Demographic, diagnoses, reason for transfer, ED resource utilization, ED disposition, and 72-hour ED return data were collected from the electronic medical record. Each encounter was classified as acute or nonacute based on previously established resource utilization criteria. This data were then compared with findings from a prior study of transfers from all urgent care centers to our institution's pediatric ED. RESULTS: A total of 240 patients met the inclusion criteria. Of these, 160 (66.7%) were discharged from the ED. Twenty-six (10.8%) of the transferred patients met the nonacute transfer criteria. The odds of nonacute transfer from pediatric urgent care were 0.66 times lower than from general urgent care (odds ratio, 0.34; 95% confidence interval, 0.18-0.93). CONCLUSIONS: A significantly lower proportion of transfers from the pediatric urgent care center were classified as nonacute, as compared with transfers from general urgent care centers. This suggests that the pediatric urgent care model may help to reduce the number of nonacute ED visits, thus producing cost savings and better patient care.

Sepsis in the urgent care setting.

Sepsis, in particular severe sepsis, is a major cause of morbidity and mortality in pediatrics. It is most likely to affect very young children and children with significant medical comorbidities. The definition of sepsis in pediatrics is currently rapidly evolving but the best treatment for children with severe sepsis remains early goal directed therapy with intravenous fluids and antibiotics. It is therefore important for any pediatric urgent care providers to be able to recognize and treat patients with severe sepsis. It is also important for pediatric urgent care providers to be aware of certain groups of patients who have an increased risk of mortality when they develop sepsis. This article summarizes the current understanding of pediatric sepsis and then focuses on the management of these patients in the pediatric urgent care setting, with special attention paid to groups at higher risks of negative outcomes.

Comparison of direct laryngoscopy to Pediatric King LT-D in simulated airways.

OBJECTIVES: Previous reports have shown a high rate of ventilation failure via direct laryngoscopy as compared with the King LT-D airway. This difference is further divergent in the pediatric population. The goal of this study was to compare the difference in efficacy of ventilation by prehospital providers in a simulated environment between direct laryngoscopy and Pedi-King LT-D. METHODS: In this study, 37 paramedics were exposed to 2 identical 5-minute clinical scenarios in a simulation center using a pediatric simulation tool. In the first scenario, the provider was given all of the standard laryngoscopy equipment. In the second scenario, they were given access only to the Pedi-King LT-D. A comparison of adequate ventilation time between the scenarios was performed. RESULTS: A mean improvement of 102 seconds was found when using the Pedi-King airway, with a clinically significant P < 0.0001. CONCLUSIONS: With a significant improvement in ventilation time in these simulated airways, consideration should be made to practice placement of the King Airway Device as first-line airway stabilization. Further live prospective studies would aid in this recommendation.