I would greatly welcome your input regarding the rules and understandings at
your EDs regarding PICU admissions.
At our site we, the ED docs, seem to have issues regarding the 'screening
process' through our PICU attendings whether a PICU admission from ED is
warranted or not.
It is my belief and understanding, almost as if COBRA or EMTALA were to be
applied in-house, that we, the ED attendings make the decision where the
patient needs to go, knowing the patient best and taking the risk regarding
appropriate admission.
I also feel that we do not 'screen out' patients, an outside physician
wanting to send us a patient because he/she feels the patient is ill enough
to be seen in our tertiary care ED, is welcome to do so...
I am not used to such problems at all my other sites I worked at in the
The AAP has some screening documents for PICU admissions. Inspecting them
'under the microscope' makes it clear, that even with those documents, it is
left up to the ED doc deciding on where the patient needs to go.

Any suggestions on how to solve the issue? I'd welcome any input.

Julia Whitefield MD, Ph.D.
T.C. Thompson Children's Hospital
University of Tennessee
Erlanger Campus

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