Complex transfer of care of surgical patients in the emergency department: Ethical and resource utilization issues

The emergency department (ED) presentation of a medically and surgically complex pediatric patient with a request to transfer medical care creates challenges for efficient evaluation and treatment. A case study of a female infant with a cloacal anomaly who presented to the ED of an academic tertiary children's hospital where she was previously unknown addresses the issues involved, including resource utilization, long ED length of stay, and establishing new physician-patient relationships. The ultimate goal is to efficiently treat acute medical and surgical issues and to establish a trusting relationship between providers, patient, and family that will lead to the best possible medical and surgical outcome.