I-PASS-to-PICU: A Structured Handoff Program to Improve Interfacility Referral Communication for PICU Transfer

Area of Science:

• Pediatric Critical Care Medicine
• Healthcare Communication
• Patient Safety

Background:

• Interfacility transfers to the Pediatric Intensive Care Unit (PICU) carry risks due to communication failures during patient handoffs.
• Handoff miscommunication can negatively impact patient outcomes and safety during critical care transfers.

Purpose of the Study:

• To evaluate the effectiveness of a structured interfacility handoff program (I-PASS-to-PICU) in enhancing communication.
• To assess improvements in information exchange between referring and receiving clinicians and the PICU admitting team.

Main Methods:

• Prospective intervention study utilizing a mixed-methods approach: surveys, chart reviews, and semistructured interviews.
• Data collected pre- and post-implementation of the I-PASS-to-PICU program in an academic tertiary referral PICU.
• Study included 220 pediatric patients (0-18 years) undergoing urgent interfacility PICU admission.

Main Results:

• No significant association between I-PASS-to-PICU use and reduced omissions of key handoff information reported by receiving physicians (OR, 0.92; p = 0.88).
• A significant decrease observed in the proportion of admitting PICU staff per patient not receiving key handoff information (16% pre vs. 10% post; p = 0.032).
• Increased reported preparedness of receiving PICU physicians (95% pre vs. 100% post; p = 0.026); however, only 50% of staff viewed the handoff note before admission.

Conclusions:

• The structured interfacility handoff program enhanced communication within the PICU admitting team and improved physician preparedness.
• Identified implementation barriers and facilitators provide insights for program refinement and broader adoption in other PICUs.
• Further optimization is needed to ensure consistent utilization of handoff documentation by all admitting staff.