Related Experiment Video
Updated: Feb 7, 2026
Manual Muscle Testing: A Method of Measuring Extremity Muscle Strength Applied to Critically Ill Patients
Published on: April 12, 2011
Improving the handover and transport of critically ill pediatric patients
Brigit VanGraafeiland1, Cynthia Foronda1, Sarah Vanderwagen1
1Johns Hopkins University School of Nursing, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland.
Insights
Improving patient handover from pediatric emergency to intensive care units requires standardized communication and transport protocols. A new process enhanced staff satisfaction and safety perceptions.
Area of Science:
- Pediatric critical care medicine
- Patient safety research
- Healthcare communication
Background:
- Patient handover and transport from pediatric emergency department (PED) to pediatric intensive care unit (PICU) is a critical juncture.
- This transition period is associated with increased vulnerability and potential for adverse events.
Purpose of the Study:
- To identify barriers within the existing handover and transport process.
- To develop and implement an improved protocol for team-to-team handover.
- To assess healthcare staff satisfaction with the newly developed process.
Main Methods:
- A mixed-methods approach utilizing a quasi-experimental design and qualitative data collection.
- Focus groups were conducted to identify barriers and facilitators.
- A multidisciplinary team developed a new process including severity of illness criteria and a standardized handover tool.
- Staff satisfaction was measured before and after the intervention.
Main Results:
- Key barriers identified included communication deficits, inter-unit cultural differences, system/process flaws, lack of standardization, and provider ambiguity regarding patient acuity.
- Post-intervention, staff reported enhanced satisfaction, improved safety perceptions, better communication, and clearer role understanding.
Conclusions:
- Standardizing handover through severity criteria and communication tools fosters shared mental models and reduces safety risks.
- A shift towards standardized team-to-team handover and transport is recommended for critically ill pediatric patients.
Aims And Objectives:
The aims of this project were to (a) determine barriers to current handover and transport process, (b) develop a new protocol and process for team-to-team handover, and (c) evaluate staff satisfaction with the new process.
Background:
The handover and transport of critically ill patients from the paediatric emergency department to the paediatric intensive care unit is a period of vulnerability associated with adverse events.
Design:
A mixed-methods study using a quasi-experimental design and qualitative approach.
Methods:
Focus groups were conducted to determine the barriers and facilitators of the current handover and transport process. Using these themes, a multidisciplinary team developed and implemented a new process including establishment of eight patient criteria for specialised transport and a standardised, interdisciplinary handover tool for team-to-team handover. Staff satisfaction was examined pre- and postintervention.
Results:
Content analysis of focus groups revealed five categories: need for improved communication, cultural dissonance among units, defects in system and processes, need for standardisation and ambiguity between providers regarding acuity. Staff members reported improvements in their perceptions of satisfaction, safety, communication and role understanding associated with the new process.
Conclusions:
Standardisation through the establishment of severity of illness criteria and communication tools creates shared mental models and decreases risks to safety. A paradigm shift of team-to-team handover and transport is recommended.
Relevance To Clinical Practice:
This paper suggests the importance of improving communication during the handover and transport process through establishing standardised patient severity of illness criteria, use of standardised tools and team-to-team handover processes.
Related Concept Videos
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
01:24Pharmacokinetics in Pediatric Patients: Drug Metabolism
01:23Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption
01:16Critical Region, Critical Values and Significance Level
In hypothesis testing, a sample statistic is converted to a test statistic using z, t, or chi-square distribution. A critical region is an area under the curve in probability distributions demarcated by the critical value. When the test statistic falls in this region, it suggests that the null hypothesis must be rejected. As this region contains all those values of the...
01:31Critical Values