Referral to the pediatric emergency service of S. Teotónio Hospital in Viseu

Abstract

Introduction: The Emergency Departments (ED) are thought to provide medical assistance to emergency and care to referred patients. The Primary Care physician is responsible for the regular attending of the healthy child, as well as the guiding, orientation and resolution of the not urgent situations. Objectives: Characterize the population referred from the Primary Care Centers to the Pediatric Emergency Department (PED), identify the causes of referrals to the PED, characterize the adequacy of the referrals, identify the attitudes taken at the hospital (diagnostic and therapeutic), and evaluate destination and orientation after hospital discharge. Study design, setting and population: Descriptive and cross-sectional study. Descriptive and cross-sectional study. It included all the children referred from the Primary Care Centers to the PED of São Teotónio Hospital (HST) - Viseu during October 2007, obtaining a sample of 459 children. Methods: The referral was considered adequate when it fulfilled at least one of the following criteria: need for complementary exams, therapy in the Emergency Department, observation by another specialty or admission.The data were collected from the family doctors information, emergency and hospital clinical files. Results: Males were more referred do PED (52.51%) that the females (47.49%). Children with ages understood between one and 4 years predominate (29.63%).The main reason of referral was trauma (102), followed by gastrointestinal pathology (69). Most children were admitted in PED between 16 p.m. and 20 p.m. (37.29%), followed by the period between the 20 p.m. and midnight (28.27%). Imagiologic studies were performed in 175 children (38.13%) and 312 (67.97%) were only observed by the Pediatrician. Therapy wasn´t needed in 66.23% of the referrals. Admission was required in nine children. Referrals were considered inadequate in 20.92% of the cases. Conclusions: The guidelines of the Direcção-Geral da Saúde for most frequent pathologies in children are suggested to improve the referral. Communication is essential to achieve a better articulation between the two levels of Health Care: Primary and Secondary.