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I-PASS-to-PICU: A Structured Handoff Program to Improve Interfacility Referral Communication for PICU Transfer
Nehal R Parikh1, Madhuradhar Chegondi2, Jessica P Liu3
1Department of Pediatrics, Division of Critical Care Medicine, Children's Mercy Hospital Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO.
Insights
A structured handoff program improved communication for interfacility pediatric intensive care unit (PICU) transfers, increasing clinician preparedness. Implementation barriers and facilitators were identified for future program adaptation.
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.
Objectives:
Interfacility transfers from frontline settings to the PICU can place children at risk for harm due to handoff miscommunication. We aimed to evaluate the effectiveness of a structured interfacility handoff program in improving communication between referring and receiving clinicians and across the PICU admitting team.
Design:
Prospective intervention study using a mixed-methods approach (surveys, chart review, and semistructured interviews) before and after I-PASS-to-PICU implementation.
Setting:
Academic tertiary referral PICU.
Patients:
Children of 0-18 years old referred by external hospitals for urgent PICU admission.
Intervention:
Structured handoff program (I-PASS-to-PICU) based on elements of high-quality handoffs adapted for interfacility PICU transfers.
Measurements And Main Results:
A total of 220 patients were included (110 preintervention and 110 postintervention). Multivariable regression analysis adjusting for potential confounders showed no association between use of I-PASS-to-PICU and receiving PICU physician reports of key handoff information omissions (OR, 0.92; 95% CI, 0.30-2.82; p = 0.88 ). However, there was a decrease in the proportion of admitting PICU staff per patient who did not receive key handoff information (mean, 16% [ sd , 21%]; preintervention, 10% [ sd , 16%] vs. postintervention; p = 0.032). There were also more patients for whom receiving PICU physicians reported being well-prepared before admission (95% preintervention vs. 100% postintervention; p = 0.026). Postintervention, 94 patients (86%) had a completed I-PASS-to-PICU note; however, only a median of 50% (IQR, 34-66%) of admitting PICU staff per patient viewed the note before admission. Stakeholders identified barriers and facilitators of I-PASS-to-PICU implementation.
Conclusions:
A structured interfacility handoff program improved communication of key information across PICU admitting team members and increased reported preparedness of receiving PICU physicians. Identified barriers and facilitators of implementation can be used to inform, redesign, and adapt this program for uptake and use in other PICUs.
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