Improving Communication in Floor-to-PICU Transfer Process QI

Introduction: Accurate communication between providers is imperative for handoff of patients requiring escalation of care to the pediatric intensive care unit (PICU). Miscommunication during this process is a significant cause of errors and increases the risk of missing necessary information. Standardized transfer acceptance bundles have been found to improve staff collaboration and satisfaction with the transfer process. However, our institution does not have a standardized handoff process from the floor resident team to the PICU. This often results in the PICU resident or APP not receiving floor sign out prior to a patient’s arrival. We hypothesize that the introduction of an EMR-based handoff template will improve the transition of care to the PICU by minimizing missed information, reducing miscommunication, and improving comfort of the accepting team.


Methods: Surveys were distributed to PICU team members to assess perceptions of the current transfer process. This was followed by a six-month observation period, during which an additional survey was conducted to assess how often handoffs from the floor residents were occurring. If a handoff occurred, participants were prompted to provide information regarding its quality. Team members were educated on the project monthly and received regular reminders to complete a survey with each transfer. An EMR-based template was then developed with input from key stakeholders. The template includes key information and can serve as a prompt during handoff. The pediatric residency program and pediatric hospitalist division were educated prior to its implementation. Secondary surveys from PICU residents and APPs are being collected to determine if handoffs are occurring more frequently, if the template is being used, and if the quality of handoffs has improved.


Results: Data collected over the six-month observation period showed that handoff occurred with only 18% of transfers from the floor to the PICU. Notably, handoff did occur more frequently when patients were more complex.


Conclusions: Pre-intervention data shows that handoff occurs infrequently during escalation of care from the hospitalist floor team to the PICU, demonstrating the need for a standardized process. An EMR-based handoff template has been implemented and data collection on its efficacy is ongoing.