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Eligibility for redirection from the pediatric emergency department: a qualitative study of professional and leader perspectives

Pediatric Research (2026)Cite this article

Abstract

Background

Redirection of non-urgent patient visits from the pediatric emergency department (ED) to community healthcare professionals may reduce crowding. As there is no consensus about who should be eligible for redirection, this qualitative study explored how health professionals conceptualize eligibility for pediatric redirection.

Methods

We completed one-on-one semi-structured interviews with pediatric ED triage nurses and physicians, office-based pediatricians and family physicians, and healthcare leaders who oversee pediatric and ED operations. Interviews were recorded, transcribed, and analyzed using reflexive thematic analysis within an interpretive description framework to generate clinically relevant insights.

Results

From our 24 interviews (6 community professionals, 11 pediatric ED professionals, and 7 healthcare leaders), we identified three guiding principles that are important to consider when developing eligibility criteria: 1. assessing the impact of presenting condition on the patient and caregivers; 2. medical complexity of the clinical condition, patient, and health system; and 3. process-related considerations.

Conclusion

This study captures referring and receiving healthcare professional perspectives about eligibility for pediatric ED redirection. The resulting guiding principles support prior work that focuses on patient characteristics and medical complexity, and also emphasizes the importance of considering family capacity, patient history, and shared decision making when creating pediatric redirection eligibility criteria.

Impact

  • Through interviews with referring and receiving healthcare professionals and health leaders, we identified guiding principles that can support identifying patients suitable for redirection from the pediatric ED.

  • The guiding principles we developed provide a structured, healthcare professional-informed foundation to determine which children may be suitable for ED redirection and highlight the importance of caregiver, health system, and process factors often overlooked in prior approaches.

  • Our guiding principles reflect health professionals’ values surrounding redirection and if applied can enhance the acceptability and sustainability of pediatric ED redirection programs.

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Fig. 1: Guiding principles to evaluate patient eligibility for redirection from the pediatric ED to community care.

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Data availability

Data (i.e., interview transcripts) cannot be shared publicly to ensure the anonymity of participants. The dataset generated during and analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank all participants for their thoughtful contributions to this work.

Funding

This study was completed without funding.

Author information

Authors and Affiliations

  1. Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    Erica Qureshi, Quynh Doan & Linda Chen

  2. British Columbia Children’s Hospital Research Institute, Vancouver, BC, Canada

    Erica Qureshi, Quynh Doan, Linda Chen, Garth Meckler & Steven P. Miller

  3. Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada

    Quynh Doan, Garth Meckler & Steven P. Miller

  4. Division of Pediatric Emergency Medicine, Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada

    Brett Burstein

  5. Department of Biostatistics, Epidemiology and Occupational Health, McGill University, Montreal, QC, Canada

    Brett Burstein

  6. Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada

    Jessica Moe

  7. BC Centre for Disease Control, Vancouver, BC, Canada

    Jessica Moe

  8. Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC, Canada

    Jessica Moe

  9. Department of Emergency Medicine, BC Children’s Hospital, Vancouver, BC, Canada

    Jessica Moe

  10. Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada

    Jehannine Austin

  11. Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada

    Jehannine Austin

Authors
  1. Erica Qureshi
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  2. Quynh Doan
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  3. Linda Chen
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  4. Garth Meckler
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  5. Brett Burstein
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  6. Jessica Moe
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  7. Steven P. Miller
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  8. Jehannine Austin
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Contributions

Study concept and design: all authors. Acquisition of the data: E.Q., Q.D., and J.A. Analysis and interpretation of the data: E.Q., J.A., Q.D., and L.C. Drafting of the manuscript: E.Q. Critical revision of the manuscript: all authors.

Corresponding author

Correspondence to Erica Qureshi.

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The authors declare no competing interests.

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All participants provided informed consent.

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Qureshi, E., Doan, Q., Chen, L. et al. Eligibility for redirection from the pediatric emergency department: a qualitative study of professional and leader perspectives. Pediatr Res (2026). https://doi.org/10.1038/s41390-026-04868-x

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