Streamlining the Interfacility Transfer Referral Process for Pediatric Seizures: A Quality Improvement Project

OBJECTIVES: As pediatric specialty care is highly regionalized, children's hospital transfer centers are essential for facilitating timely access to subspecialty care. Seizures are a common diagnosis for transfer requests, but the lack of a standardized triage process leads to inefficient and potentially inappropriate referral decisions. For this QI initiative, our aim was to implement standardized triage guidelines to improve identification of the appropriate subspecialist for children referred with seizures. METHODS: In 2024, a multidisciplinary team of transfer center staff, neurologists, and medical control physicians (MCPs) used the Model for Improvement framework. MCPs are pediatric intensivists who oversee transfer and patient care decisions during interfacility referrals. Key interventions included standardizing the seizure referral pathway and optimizing the electronic health record. The primary outcome was seizure guideline utilization. The secondary outcome was neurology consult-only encounters, and the process measure was the proportion of referrals directed to neurology. The balancing measure was a 24-hour ED revisit after consult-only management. RESULTS: Guideline utilization increased from 0% to 100% within 6 months and was sustained thereafter. Neurology consult-only referrals increased from 31% to 58% while referrals directed to neurology increased from 56% to 85%. No patients managed with consult-only returned to their community ED within 24 hours. CONCLUSIONS: Implementation of a standardized seizure referral pathway improved access to pediatric neurology expertise while reducing potentially avoidable interfacility transfers.