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Interfacility Referral Communication for PICU Transfer
Caitlin K Thirnbeck1, Elizabeth T Espinoza2, Elizabeth A Beaman3
1Division of Critical Care, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL.
Insights
Verbal handoffs for urgent pediatric interfacility transfers to the Pediatric Intensive Care Unit (PICU) share similarities with intrahospital handoffs but lack key elements of high-quality communication. Structured tools are needed to improve PICU transfer communication and patient outcomes.
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.
Objectives:
For patients requiring transfer to a higher level of care, excellent interfacility communication is essential. Our objective was to characterize verbal handoffs for urgent interfacility transfers of children to the PICU and compare these characteristics with known elements of high-quality intrahospital shift-to-shift handoffs.
Design:
Mixed methods retrospective study of audio-recorded referral calls between referring clinicians and receiving PICU physicians for urgent interfacility PICU transfers.
Setting:
Academic tertiary referral PICU.
Patients:
Children 0-18 years old admitted to a single PICU following interfacility transfer over a 4-month period (October 2019 to January 2020).
Interventions:
None.
Measurements And Main Results:
We reviewed interfacility referral phone calls for 49 patients. Referral calls between clinicians lasted a median of 9.7 minutes (interquartile range, 6.8-14.5 min). Most referring clinicians provided information on history (96%), physical examination (94%), test results (94%), and interventions (98%). Fewer clinicians provided assessments of illness severity (87%) or code status (19%). Seventy-seven percent of referring clinicians and 6% of receiving PICU physicians stated the working diagnosis. Only 9% of PICU physicians summarized information received. Interfacility handoffs usually involved: 1) indirect references to illness severity and diagnosis rather than explicit discussions, 2) justifications for PICU admission, 3) statements communicating and addressing uncertainty, and 4) statements indicating the referring hospital's reliance on PICU resources. Interfacility referral communication was similar to intrahospital shift-to-shift handoffs with some key differences: 1) use of contextual information for appropriate PICU triage, 2) difference in expertise between communicating clinicians, and 3) reliance of referring clinicians and PICU physicians on each other for accurate information and medical/transport guidance.
Conclusions:
Interfacility PICU referral communication shared characteristics with intrahospital shift-to-shift handoffs; however, communication did not adhere to known elements of high-quality handovers. Structured tools specific to PICU interfacility referral communication must be developed and investigated for effectiveness in improving communication and patient outcomes.
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