Pediatric emergency room response to community pediatricians' expectations

Background: In Israel the pediatric emergency room functions as an urgent p rimary care clinic in addition to dealing with life-threatening situations. Due to health insurance stipulations, most patients come to the PER with a referral from the community clinic. The relationship between the referring physician's expectations and the subsequent management of the referred pat ient in the PER is not well defined. Objectives: To evaluate the relationship between the expectations of the pr imary care physician and the management of referred patients in the PER, as sess the type of information provided by the referring physician, and exami ne the effect of additional information obtained from the referring physici an on patient management in the PER. Methods: We reviewed the records of patients presenting at the PER with ref errals from primary care physicians as well as additional information obtai ned by telephone interviews with the referring physicians. Results: The expectations of the referring physicians were not fully docume nted in the referral form. The PER responded to the patient as if the PER w as the initial contact. There was no significant difference in the response of PER physicians with or without additional information from the referrin g physicians. Conclusions: The PER acts as an independent unit with no obligation to sati sfy the expectations of the referring physicians. The relationship between the PER and the referring physicians needs to be clarified. Guidelines and structured PER referral forms should be implemented in all primary care cli nics to improve patient management and communication between health provide rs.