Optimizing Non-Emergent NICU-to-PICU Transfers: Perspectives of Pediatric Intensivists

Introduction: Previous studies have demonstrated that there is a considerable population of NICU-to-PICU transfers with complex medical needs and high relative mortality. From these long-stay admissions, research suggests caregivers are at increased risk of post-intensive care syndrome and providers are at increased risk for burnout. Despite evidence that patient harm can be induced by transfer, no guidance for best practices exists to optimize these transitions for patients, families, and clinicians. Using a qualitative approach, we aimed to characterize facilitators and barriers of effective NICU-to-PICU transfers among pediatric intensivists.


Methods: Semi-structured interviews were conducted with pediatric intensivists recruited from a previous national survey. Interviews were recorded, transcribed, and qualitatively analyzed using an iterative process to elicit themes. Interviews will continue until thematic saturation is reached.


Results: Ten interviews have been conducted to date, with a median duration of 38 minutes (range 29-46 minutes). Intensivists interviewed represented unique PICUs ranging from 16-40 beds at academic medical centers. Notable themes emerged in the pre-transfer, transfer, and post-transfer phases. Pre-transfer themes included (1) prioritizing patient needs, which was facilitated by routine NICU-PICU joint meetings and hindered by bed capacity challenges and (2) expectation setting with families, which was subject to the ability to have PICU personnel meet with family pre-transfer. Peri-transfer, facilitators included (3) multidisciplinary communication beyond the physician teams and (4) care overlap (e.g. joint rounding or NICU consult shortly after transfer). Post-transfer, differences in (5) medical care as well as (6) unit culture were identified as having the potential to both improve the therapeutic alliance with families or slow patient progress toward discharge.


Conclusions: In this qualitative study, pediatric intensivists have begun to identify aspects of non-emergent NICU-to-PICU transfer that make such transfers either more effective or more challenging. Components of care that optimize effectiveness rely on advanced planning, multidisciplinary input, and directly addressing differences in NICU and PICU care with families.