(370003-15) I-PASS-to-PICU: Implementing Standard Interfacility Referral Handoffs for Pediatric ICU Transfer

Introduction: Miscommunication during inter-facility handoffs leads to poor outcomes. We developed a standard handoff intervention (I-PASS-to-PICU) based on I-PASS, adapted to inter-facility transfers to the pediatric ICU (PICU). I-PASS-to-PICU uses an electronic health record (EHR) template to guide verbal communication between referring and receiving clinicians, facilitates real-time documentation, and provides the multi-disciplinary PICU admitting team immediate access to referral information. Our objective was to assess I-PASS-to-PICU’s effectiveness in improving communication.

Methods: Our interrupted time-series study included patients referred for inter-facility PICU transfer (8 months pre-/1 month washout/4 months post-intervention). At baseline, verbal referral call communication was unstructured and not documented in the EHR. Receiving PICU fellows relayed patient referral information to the PICU admitting team ad hoc. We held education sessions and PICU fellow simulations to train staff on I-PASS-to-PICU use. The primary outcome was omission of key information (illness severity, patient summary, action items, situation awareness, synthesis), captured through post-admission staff surveys. Implementation outcomes were I-PASS-to-PICU adoption and fidelity. Clinician interviews are ongoing to determine implementation barriers/facilitators.

Results: 110 patients were included pre- and 105 post-intervention. I-PASS-to-PICU was used in 87% of patients post-implementation. Staff surveys (76% response rate) revealed fewer key information omissions overall (15.2% pre vs. 9.6% post). Additionally, handoff efficiency improved: more PICU staff reported needing just < 15min to communicate with other staff (80% pre vs. 72% post) and fewer PICU fellows reported discrepancies in clinical status between referral call and admission (14% pre vs. 8% post). Patient/clinician characteristics were similar pre vs. post. Qualitative interview results and final analyses are pending.

Conclusions: Key information omissions decreased following I-PASS-to-PICU implementation. Program adoption and implementation fidelity were high. Future multi-center research should evaluate program effectiveness in reducing harm.