Predictors of bounce back for children redirected by triage nurses from the pediatric emergency department.

objectivesTo address crowding, our pediatric emergency department (ED) implemented a triage nurse-led protocol to redirect non-urgent patients to external pediatric clinics, other healthcare providers, family physicians, or home. This study aimed to identify the proportion of redirected children who returned to the ED and identify predictors of return.

methodsWe conducted a health records review study of children under 18 years redirected from the ED of a tertiary pediatric hospital in Montreal, Canada. A random sample of 150 return visits and 300 controls was selected for a nested case-control study. The primary outcome was a return visit to the ED within 7 days. Potential predictors included demographic information, disease characteristics, triage level, and initial orientation. We calculated the proportion of return visits and performed univariate and multivariable analyses of identified predictors.

resultsBetween September 2023 and August 2024, 80,221 children were triaged, of whom 6,556 (8.2%) were redirected. Within 7 days, 372 (5.7%) returned. Among the 150 reviewed return visits, 127 (85%) were related to the initial complaint: 64 (43%) were due to persistent symptoms, 49 (33%) to clinical deterioration, 6 (4%) were sent back by a physician, and 5 (3%) were for new symptoms. Seven patients (4.7%) required hospitalization on their return visit. Predictors associated with a lower probability of return included ear, nose, throat, and dental complaints, as well as redirection to specialized or pediatric clinics.

conclusionsApproximately, 6% of redirected children returned to the ED within 7 days, most often for persistent or worsening symptoms. Identifying predictors of return visits provides evidence to refine redirection guidelines and enhance the safety and effectiveness of triage nurse-led redirection strategies.