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Before effective educational interventions can be implemented to improve health care, a needs assessment is essential to determine areas best targeted for improvement. The purpose of this study was to assess the educational needs of referring community hospitals with regard to the pretransport care of pediatric patients.We performed a prospective survey of physicians accepting referrals from community hospitals in the emergency department of a large, urban, academic, pediatric hospital. Based on the routine pretransport telephone consultation, we asked the accepting physician to document the appropriateness of the referring hospital's management of the patient before the request for transport. We reviewed the corresponding transport records of all children for whom pretransport care was categorized as suboptimal. We report frequencies and relative frequencies for suboptimal care, reasons for suboptimal care, and the pretransport diagnoses of these patients.There were 817 pediatric patients transported from 54 different hospitals during the 3-month study period, for which we received 477 surveys (58% response rate). The accepting physician rated the pretransport care as suboptimal for 105 (22%) of 477 patients. The most common diagnoses of referrals were respiratory distress, asthma, and seizures. Care was more likely to be reported suboptimal for patients with fever (P = 0.001) and asthma (P = 0.04).Using a simple survey, we identified opportunities for improvement in the management of pediatric emergency patients by referring hospitals in 22% of cases.