Interfacility Referral Communication for PICU Transfer

Author:

Thirnbeck Caitlin K.1,Espinoza Elizabeth T.2,Beaman Elizabeth A.3,Rozen Alexis L.4,Dukes Kimberly C.56,Singh Hardeep7,Herwaldt Loreen A.58,Landrigan Christopher P.910,Reisinger Heather Schacht511,Cifra Christina L.1213

Affiliation:

1. Division of Critical Care, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL.

2. Oregon Health and Science University School of Nursing and Department of Pediatrics, Division of Critical Care, School of Medicine, Portland, OR.

3. University of Iowa College of Public Health, Iowa City, IA.

4. University of Iowa College of Liberal Arts and Sciences, Iowa City, IA.

5. Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA.

6. Department of Community and Behavioral Health, University of Iowa Carver College of Medicine, Iowa City, IA.

7. Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX.

8. Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA.

9. Division of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, MA.

10. Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA.

11. Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA.

12. Division of Medical Critical Care, Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, MA.

13. 13 Division of Critical Care, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA.

Abstract

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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