Attending-Provider Handoffs and Pediatric Emergency Department Revisits

OBJECTIVE: The objective of this study was to determine if intradepartment attending-provider transitions of care (handoffs) during a pediatric emergency department (ED) encounter were associated with return ED visits resulting in hospitalization. METHODS: We analyzed ED encounters for patients younger than 21 years discharged from a single pediatric ED from January 2013 to February 2017. We classified an encounter as having a handoff when the initial attending and discharging attending differed. Our primary outcome was a revisit within 72 hours resulting in hospitalization. Our secondary outcomes were any revisit within 72 hours and revisits resulting in hospitalization with potential deficiencies in care. We compared outcome rates for ED encounters with and without provider handoffs, both with and without adjustment for demographic, clinical, and visit characteristics. RESULTS: Of the 177,350 eligible ED encounters, 1961 (1.1%) had a return visit resulting in hospitalization and 6821 (3.9%) had any return visit. In unadjusted analyses, handoffs were associated with an increased likelihood of a return visit resulting in hospitalization (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.26-1.70) or any return visit (OR, 1.20; 95% CI, 1.10-1.31). However, after adjustment, provider handoffs were not associated with return ED visits resulting in hospitalization (OR, 0.96; 95% CI, 0.81-1.13) or any return ED visits (OR, 1.00; 95% CI, 0.90-1.10). CONCLUSIONS: Provider handoffs in a pediatric ED did not increase the risk of return ED visits or return ED visits with deficiencies in care after adjustment for demographic, clinical, and visit factors.