Interfacility Referral Communication for PICU Transfer

Area of Science:

• Pediatric critical care medicine
• Healthcare communication
• Patient transfer protocols

Background:

• Effective interfacility communication is crucial for patients needing transfer to a higher level of care.
• Urgent transfers to the Pediatric Intensive Care Unit (PICU) require clear and concise information exchange between referring and receiving clinicians.

Purpose of the Study:

• To characterize verbal handoffs during urgent interfacility transfers of children to the PICU.
• To compare these handoffs with established elements of high-quality intrahospital shift-to-shift handoffs.

Main Methods:

• A mixed-methods retrospective study analyzing audio-recorded referral calls.
• Involved urgent interfacility transfers of pediatric patients to an academic tertiary referral PICU.
• Data collected over a 4-month period from October 2019 to January 2020.

Main Results:

• Referral calls averaged 9.7 minutes, with most clinicians providing history, exam, and intervention details.
• Fewer clinicians explicitly discussed illness severity (87%) or code status (19%).
• Communication often involved indirect references, justifications for PICU admission, and addressed uncertainty, differing from high-quality intrahospital handoffs.

Conclusions:

• Interfacility PICU referral communication shares some traits with intrahospital handoffs but does not consistently meet high-quality standards.
• There is a need for developing and evaluating structured communication tools tailored for PICU interfacility transfers.
• Improving communication is essential for enhancing patient outcomes during critical care transfers.