Inter-shift variation in unscheduled intensive care unit transfers at a children's hospital

Area of Science:

• Pediatric critical care medicine
• Patient safety research
• Healthcare quality improvement

Background:

• Early detection of patient deterioration and timely care escalation are critical in general hospital wards.
• Limited staffing and resources, particularly at night, can impede prompt interventions.
• Understanding work shift variations in unscheduled intensive care unit (ICU) transfers is key to improving patient safety.

Purpose of the Study:

• To analyze the frequency and characteristics of unscheduled ICU transfers across different work shifts.
• To identify variations in safe transfers versus adverse safety events (ASE) between day, evening, and night shifts.
• To inform targeted interventions for reducing delayed transfers and enhancing patient outcomes.

Main Methods:

• Retrospective review of all unscheduled ICU transfers from January 2013 to December 2016 in a tertiary children's hospital.
• Categorization of transfers into safe transfers and adverse safety events (ASE).
• Comparative analysis of transfer numbers and ASE proportions across day, evening, and night shifts.

Main Results:

• A total of 244 unscheduled ICU transfers were analyzed: 167 safe transfers and 77 ASE.
• The highest number of transfers and ASE occurred during the day shift (133 transfers, 40 ASE).
• The proportion of ASE was notably higher during the night shift (48%) compared to day (30%) and evening (31%) shifts.

Conclusions:

• Unscheduled ICU transfers were less common at night, but a higher proportion of these transfers involved adverse safety events (ASE).
• Day shifts had the highest volume of transfers and ASE.
• Further research is needed to understand the underlying reasons for these shift-based variations in transfer safety.