Caitlin Thirnbeck, DO, MPH
Pediatric Resident
University of Iowa Stead Family Children's Hospital
Iowa City, IA
Disclosure information not submitted.
Elizabeth Espinoza, DNP, CPNP-AC
Pediatric Nurse Practitioner
University of Iowa Stead Family Childrens's Hospital, United States
Disclosure information not submitted.
Elizabeth Beaman, BS
Research Coordinator
University of Iowa, United States
Disclosure information not submitted.
Kimberly Dukes, PhD
Research Assistant Professor
University of Iowa Carver College of Medicine, United States
Disclosure information not submitted.
Hardeep Singh, MD, MPH
Professor
Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, United States
Disclosure information not submitted.
Loreen Herwaldt, MD
Professor
University of Iowa Carver College of Medicine, United States
Disclosure information not submitted.
Heather Reisinger, PhD
Associate Professor
University of Iowa Institute for Clinical and Translational Science and Department of Internal Medicine, United States
Disclosure information not submitted.
Christina Cifra, MD, MS
Clinical Associate Professor
University of Iowa
Iowa City, IA
Disclosure information not submitted.
Title: Clinicians’ Referral Communication for Interhospital Pediatric Critical Care Admission
Introduction: Referral communication between clinicians during transitions of care from emergency to pediatric intensive care unit (PICU) settings is critical. We determined the characteristics of clinicians’ verbal communication during interhospital transfer of critically ill children to the PICU and described adherence to elements of effective handoffs (I-PASS guidelines).
Methods: We conducted a retrospective mixed methods study of 49 patients admitted to a single tertiary-referral PICU following interhospital transfer. We used stratified random selection to select a variety of patients from different referring institutions with referral calls received by 6 critical care fellows at different levels of training. We collected data on patients and clinicians from electronic medical records and determined verbal communication characteristics from recorded referral calls. We report preliminary quantitative data; qualitative analysis of referral calls are ongoing.
Results: 49 patients had a median age of 1.2 (IQR 0.4-8.3) yrs and median pediatric risk of mortality-III score of 3 (IQR 0-7). Patients were transferred directly to the PICU from 20 institutions by 43 unique clinicians. Communication between the referring clinician and PICU fellow lasted a median of 9.7 (IQR 6.8-14.5) mins. Most referring clinicians gave patient summaries including history (96%), physical exam (94%), test results (94%), and interventions (98%); fewer gave an assessment of illness severity (87%) or code status (19%). 77% of referring clinicians stated their primary diagnosis and 6% of PICU fellows stated their own diagnosis; 9% of PICU fellows summarized information received from the referring clinician. 44% of referring clinicians and 98% of PICU fellows asked questions; 77% of PICU fellows gave medical recommendations. 13% of calls included negative interpersonal interactions (rude and dismissive behavior) between the referring clinician and PICU fellow.
Conclusions: Verbal communication between clinicians for interhospital transfer of children to the PICU adhered to some (patient summary) but not all (illness severity, summary by receiver) elements of the I-PASS guidelines, showing areas for improvement. Other I-PASS elements (providing an action list, contingency planning) are being examined in ongoing qualitative analysis.