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I feel your pain! In my former position, when I was on call, all outside requests for admission to our children's hospital came through me. I generally stuck with the policy of accept all patients for the same reasons you site--relationship with the referring facility, desire to reassure the family everything is being done, fear that the child is sicker than the impression the referring facility is relaying to me. There were many admissions that went home the next day without any further testing, invasive monitoring or subspecialty consult. I struggle with the bigger, public health question of what cost and risk am I adding to the health care system by transferring, admitting and billing these children. I pondered if the families were relieved or annoyed by spending a few hours in our children's hospital with as much as 6 hour transports. On the rare occassion I took the route you did last night, I too worried the rest of the night as to whether I had done the right thing. I wanted to, but never had the nerve, to check the next day and see if the referring hospital called another pediatric center to transfer the patient or followed my instruction. If I attempted to not accept the patient and the referring facility protested, I was fairly fast to back down, not wanting to alienate the referring center.
Most of our transports were helicopter without specialized pediatric teams which worried me that I could cause more harm in accepting them. This was balanced against many of the rural ERs being staffed by midlevels with little pediatric experience. I always was trying to balance the risk of the transfer againt the posibility that the referring care provider was not clearly describing the patient to me.
In summery, I think you did the correct thing, but surprisingly to those who have never been in your position, the more difficult thing!

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