Development and Evaluation of I-PASS-to-PICU: A Standard Electronic Template to Improve Referral Communication for Interfacility Transfers to the Pediatric ICU
Nehal R. Parikh DO (is Fellow Physician, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.), Leticia S. Francisco (is Pre-Med Student, College of Liberal Arts and Sciences, University of Iowa.), Shilpa C. Balikai DO (is Clinical Associate Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.), Mitchell A. Luangrath MD (is Clinical Assistant Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.), Heather R. Elmore DNP, ARNP (is Pediatric Nurse Practitioner, Pediatric Intensive Care Unit, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa.), Jennifer Erdahl MSN, RN, CCRN-K (is Nurse Manager, Pediatric Intensive Care Unit, University of Iowa Stead Family Children's Hospital.), Aditya Badheka MBBS, MS (is Clinical Associate Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.), Madhuradhar Chegondi MBBS, MD (is Clinical Associate Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.), Christopher P. Landrigan MD, MPH (is Chief, Division of General Pediatrics, Boston Children's Hospital, and Director, Sleep and Patient Safety Program, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital / Harvard Medical School, Boston.), Priyadarshini Pennathur PhD (is Associate Professor, Department of Industrial, Manufacturing, and Systems Engineering, University of Texas at El Paso.), Heather Schacht Reisinger PhD (is Associate Professor, Department of Internal Medicine, Carver College of Medicine, University of Iowa, and Core Investigator, Institute for Clinical and Translational Science, University of Iowa.), Christina L. Cifra MD, MS (is Assistant Professor, Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital / Harvard Medical School and Adjunct Associate Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa. Please address correspondence to Christina L. Cifra)
{"title":"Development and Evaluation of I-PASS-to-PICU: A Standard Electronic Template to Improve Referral Communication for Interfacility Transfers to the Pediatric ICU","authors":"Nehal R. Parikh DO (is Fellow Physician, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.), Leticia S. Francisco (is Pre-Med Student, College of Liberal Arts and Sciences, University of Iowa.), Shilpa C. Balikai DO (is Clinical Associate Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.), Mitchell A. Luangrath MD (is Clinical Assistant Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.), Heather R. Elmore DNP, ARNP (is Pediatric Nurse Practitioner, Pediatric Intensive Care Unit, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa.), Jennifer Erdahl MSN, RN, CCRN-K (is Nurse Manager, Pediatric Intensive Care Unit, University of Iowa Stead Family Children's Hospital.), Aditya Badheka MBBS, MS (is Clinical Associate Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.), Madhuradhar Chegondi MBBS, MD (is Clinical Associate Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa.), Christopher P. Landrigan MD, MPH (is Chief, Division of General Pediatrics, Boston Children's Hospital, and Director, Sleep and Patient Safety Program, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital / Harvard Medical School, Boston.), Priyadarshini Pennathur PhD (is Associate Professor, Department of Industrial, Manufacturing, and Systems Engineering, University of Texas at El Paso.), Heather Schacht Reisinger PhD (is Associate Professor, Department of Internal Medicine, Carver College of Medicine, University of Iowa, and Core Investigator, Institute for Clinical and Translational Science, University of Iowa.), Christina L. Cifra MD, MS (is Assistant Professor, Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital / Harvard Medical School and Adjunct Associate Professor, Division of Pediatric Critical Care, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa. Please address correspondence to Christina L. Cifra)","doi":"10.1016/j.jcjq.2024.01.010","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Miscommunication during interfacility handoffs to a higher level of care can harm critically ill children. Adapting evidence-based handoff interventions to interfacility referral communication may prevent adverse events. The objective of this project was to develop and evaluate a standard electronic referral template (I-PASS-to-PICU) to improve communication for interfacility pediatric ICU (PICU) transfers.</p></div><div><h3>Methods</h3><p>I-PASS-to-PICU was iteratively developed in a single PICU. A core PICU stakeholder group collaboratively designed an electronic health record (EHR)–supported clinical note template by adapting elements from I-PASS, an evidence-based handoff program, to support information exchange between referring clinicians and receiving PICU physicians. I-PASS-to-PICU is a receiver-driven tool used by PICU physicians to guide verbal communication and electronic documentation during PICU transfer calls. The template underwent three cycles of iterative evaluation and redesign informed by individual and group interviews of multidisciplinary PICU staff, usability testing using simulated and actual referral calls, and debriefing with PICU physicians.</p></div><div><h3>Results</h3><p>Individual and group interviews with 21 PICU staff members revealed that relevant, accurate, and concise information was needed for adequate admission preparedness. Time constraints and secondhand information transmission were identified as barriers. Usability testing with six receiving PICU physicians using simulated and actual calls revealed good usability on the validated System Usability Scale (SUS), with a mean score of 77.5 (standard deviation 10.9). Fellows indicated that most fields were relevant and that the template was feasible to use.</p></div><div><h3>Conclusion</h3><p>I-PASS-to-PICU was technically feasible, usable, and relevant. The authors plan to further evaluate its effectiveness in improving information exchange during real-time PICU practice.</p></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Joint Commission journal on quality and patient safety","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1553725024000394","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
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Abstract
Background
Miscommunication during interfacility handoffs to a higher level of care can harm critically ill children. Adapting evidence-based handoff interventions to interfacility referral communication may prevent adverse events. The objective of this project was to develop and evaluate a standard electronic referral template (I-PASS-to-PICU) to improve communication for interfacility pediatric ICU (PICU) transfers.
Methods
I-PASS-to-PICU was iteratively developed in a single PICU. A core PICU stakeholder group collaboratively designed an electronic health record (EHR)–supported clinical note template by adapting elements from I-PASS, an evidence-based handoff program, to support information exchange between referring clinicians and receiving PICU physicians. I-PASS-to-PICU is a receiver-driven tool used by PICU physicians to guide verbal communication and electronic documentation during PICU transfer calls. The template underwent three cycles of iterative evaluation and redesign informed by individual and group interviews of multidisciplinary PICU staff, usability testing using simulated and actual referral calls, and debriefing with PICU physicians.
Results
Individual and group interviews with 21 PICU staff members revealed that relevant, accurate, and concise information was needed for adequate admission preparedness. Time constraints and secondhand information transmission were identified as barriers. Usability testing with six receiving PICU physicians using simulated and actual calls revealed good usability on the validated System Usability Scale (SUS), with a mean score of 77.5 (standard deviation 10.9). Fellows indicated that most fields were relevant and that the template was feasible to use.
Conclusion
I-PASS-to-PICU was technically feasible, usable, and relevant. The authors plan to further evaluate its effectiveness in improving information exchange during real-time PICU practice.
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