Interfacility Transfer and Admission to PICUs in the United States: Survey of Referral Communications in 2023.

Abstract

Objectives: Poor communication during interfacility transfer to the PICU can harm critically ill children. Structured handoff communication can prevent harm; however, the landscape of interfacility referral communication practices across PICUs is unknown. Our objective was to describe interfacility referral communication practices among U.S. PICUs to begin identifying potential improvement opportunities.

Design: Mixed methods study including a cross-sectional survey and semi-structured interviews.

Setting: U.S. PICUs with greater than or equal to 10 beds in 2023.

Participants: Clinical/administrative PICU leaders.

Interventions: None.

Measurements and main results: Sixty surveys with greater than 70% completed questions were returned from 170 invited participants (35% response rate). Respondents were mainly pediatric critical care medicine division chiefs (48%) or PICU medical directors (32%). PICUs in all U.S. continental regions were represented, which had a median of 1200 (interquartile range [IQR], 1000-1500) admissions per year, of which 29.5% (IQR, 15-39%) were patients directly transferred from other institutions. In 93% of PICUs, a verbal interfacility handoff occurs between the referring clinician and a PICU physician; however, only 24% were always guided by a standard communication tool. In 72% of PICUs, medical records were only sometimes available before patient arrival. Semi-structured interviews with seven volunteer respondents revealed the following themes: 1) standardizing communication can result in organized and efficient handoffs but may also result in inefficiencies, 2) trained staff dedicated to interfacility referrals will improve communication quality, 3) integration of handoff information into the electronic health record will improve dissemination and decrease PICU physicians' workload, and 4) implementing a structured process will require staff support to change current workflows.

Conclusions: Referral communication for interfacility patient transfers to the PICU occurred mainly through unstructured verbal handoffs between referring clinicians and PICU physicians. PICU leaders identified several potential benefits and challenges of standardizing interfacility referral communication.