Journal article
Interfacility Transfer and Admission to PICUs in the United States: Survey of Referral Communications in 2023
Pediatric critical care medicine, Vol.26(5), pp.e669-e679
05/2025
DOI: 10.1097/PCC.0000000000003702
PMCID: PMC12061564
PMID: 39918372
Abstract
Poor communication during interfacility transfer to the PICU can harm critically ill children. Structured handoff communication can prevent harm; however, the landscape of interfacility referral communication practices across PICUs is unknown. Our objective was to describe interfacility referral communication practices among U.S. PICUs to begin identifying potential improvement opportunities.
Mixed methods study including a cross-sectional survey and semi-structured interviews.
U.S. PICUs with greater than or equal to 10 beds in 2023.
Clinical/administrative PICU leaders.
None.
Sixty surveys with greater than 70% completed questions were returned from 170 invited participants (35% response rate). Respondents were mainly pediatric critical care medicine division chiefs (48%) or PICU medical directors (32%). PICUs in all U.S. continental regions were represented, which had a median of 1200 (interquartile range [IQR], 1000-1500) admissions per year, of which 29.5% (IQR, 15-39%) were patients directly transferred from other institutions. In 93% of PICUs, a verbal interfacility handoff occurs between the referring clinician and a PICU physician; however, only 24% were always guided by a standard communication tool. In 72% of PICUs, medical records were only sometimes available before patient arrival. Semi-structured interviews with seven volunteer respondents revealed the following themes: 1) standardizing communication can result in organized and efficient handoffs but may also result in inefficiencies, 2) trained staff dedicated to interfacility referrals will improve communication quality, 3) integration of handoff information into the electronic health record will improve dissemination and decrease PICU physicians' workload, and 4) implementing a structured process will require staff support to change current workflows.
Referral communication for interfacility patient transfers to the PICU occurred mainly through unstructured verbal handoffs between referring clinicians and PICU physicians. PICU leaders identified several potential benefits and challenges of standardizing interfacility referral communication.
Details
- Title: Subtitle
- Interfacility Transfer and Admission to PICUs in the United States: Survey of Referral Communications in 2023
- Creators
- Christina L Cifra - Boston Children's HospitalOlivia Lin - Harvard UniversityCelestine L Gonzales - Northeastern UniversityIrene Pantekidis - Harvard UniversityMadhuradhar Chegondi - University of IowaAna Lia Graciano - University of Maryland, BaltimoreEleanor Gradidge - University of Nebraska Medical CenterMatthew P Malone - Arkansas Children's HospitalMatthew H M Marx - Case Western Reserve UniversityNehal R Parikh - University of IowaCharlotte Z Woods-Hill - Children's Hospital of PhiladelphiaChristopher P Landrigan - Boston Children's HospitalPediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
- Resource Type
- Journal article
- Publication Details
- Pediatric critical care medicine, Vol.26(5), pp.e669-e679
- DOI
- 10.1097/PCC.0000000000003702
- PMID
- 39918372
- PMCID
- PMC12061564
- NLM abbreviation
- Pediatr Crit Care Med
- ISSN
- 1529-7535
- eISSN
- 1947-3893
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Grant note
- Institutional Centers for Clinical and Translational Research at Boston Children's Hospital - Harvard Catalyst/The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences/National Institutes of Health): UM1TR004408
This work was supported by the Institutional Centers for Clinical and Translational Research at Boston Children's Hospital, which is partly funded by Harvard Catalyst/The Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences/National Institutes of Health No. UM1TR004408).
- Language
- English
- Electronic publication date
- 02/07/2025
- Date published
- 05/2025
- Academic Unit
- Stead Family Department of Pediatrics
- Record Identifier
- 9984786442902771
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