Diagnosis-related handoffs for inter-facility transfers to the pediatric intensive care unit

Inter-facility transfers to the pediatric intensive care unit (PICU) increase the risk of patient harm from communication breakdowns. We previously developed I-PASS-to-PICU, a structured inter-facility handoff program to improve information exchange during these transitions. However, it was not designed to optimize communication related to diagnosis (diagnostic handoff). This exploratory study evaluated how well I-PASS-to-PICU facilitated inter-facility diagnostic handoffs.

Using mixed methods, we analyzed audio-recorded referral calls to a single PICU to characterize inter-facility diagnostic handoff communication before and after I-PASS-to-PICU implementation. Two pediatric intensivists trained to review calls indicated whether diagnosis-relevant information or activities were discussed. Discrepancies in review were resolved via consensus. Reviewers also provided qualitative observations on diagnosis-related discussions.

Forty-four referral calls were reviewed (16 pre-and 28 post-I-PASS-to-PICU implementation). Compared with unstructured handoffs, I-PASS-to-PICU use did not result in statistically significant differences in the communication of diagnosis-related information in inter-facility handoffs. However, we observed some absolute differences; there were more calls using I-PASS-to-PICU in which illness severity was discussed (75 % vs. 50 %) and the primary diagnosis was stated by the referring clinician (68 % vs. 44 %) or receiving PICU physician (39 % vs. 25 %). Qualitative analysis revealed that shared mental models were more effectively created when primary diagnoses and diagnostic uncertainty were discussed.

I-PASS-to-PICU may support aspects of the inter-facility diagnostic handoff but needs further revision to facilitate consistent discussion of diagnoses and diagnostic uncertainty. Future work will focus on redesigning and evaluating I-PASS-to-PICU for improving the diagnostic handoff during inter-facility PICU transfers.