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Thirnbeck CK, Espinoza ED, Beaman EA, Rozen AL, Dukes KC, Singh H, Herwaldt LA, Landrigan CP, Reisinger HS, Cifra CL. Interfacility Referral Communication for PICU Transfer. Pediatr Crit Care Med 2024; 25:499-511. [PMID: 38483193 PMCID: PMC11153023 DOI: 10.1097/pcc.0000000000003479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVES For patients requiring transfer to a higher level of care, excellent interfacility communication is essential. Our objective was to characterize verbal handoffs for urgent interfacility transfers of children to the PICU and compare these characteristics with known elements of high-quality intrahospital shift-to-shift handoffs. DESIGN Mixed methods retrospective study of audio-recorded referral calls between referring clinicians and receiving PICU physicians for urgent interfacility PICU transfers. SETTING Academic tertiary referral PICU. PATIENTS Children 0-18 years old admitted to a single PICU following interfacility transfer over a 4-month period (October 2019 to January 2020). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We reviewed interfacility referral phone calls for 49 patients. Referral calls between clinicians lasted a median of 9.7 minutes (interquartile range, 6.8-14.5 min). Most referring clinicians provided information on history (96%), physical examination (94%), test results (94%), and interventions (98%). Fewer clinicians provided assessments of illness severity (87%) or code status (19%). Seventy-seven percent of referring clinicians and 6% of receiving PICU physicians stated the working diagnosis. Only 9% of PICU physicians summarized information received. Interfacility handoffs usually involved: 1) indirect references to illness severity and diagnosis rather than explicit discussions, 2) justifications for PICU admission, 3) statements communicating and addressing uncertainty, and 4) statements indicating the referring hospital's reliance on PICU resources. Interfacility referral communication was similar to intrahospital shift-to-shift handoffs with some key differences: 1) use of contextual information for appropriate PICU triage, 2) difference in expertise between communicating clinicians, and 3) reliance of referring clinicians and PICU physicians on each other for accurate information and medical/transport guidance. CONCLUSIONS Interfacility PICU referral communication shared characteristics with intrahospital shift-to-shift handoffs; however, communication did not adhere to known elements of high-quality handovers. Structured tools specific to PICU interfacility referral communication must be developed and investigated for effectiveness in improving communication and patient outcomes.
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Affiliation(s)
- Caitlin K. Thirnbeck
- Division of Critical Care, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Elizabeth D. Espinoza
- Oregon Health and Science University School of Nursing and School of Medicine, Portland, Oregon
| | | | - Alexis L. Rozen
- University of Iowa College of Public Health, Iowa City, Iowa
| | - Kimberly C. Dukes
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas
| | - Loreen A. Herwaldt
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
| | - Christopher P. Landrigan
- Division of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Heather Schacht Reisinger
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa
| | - Christina L. Cifra
- Division of Medical Critical Care, Department of Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Critical Care, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Woods J, Markovitz BP. Playing Telephone: Characterizing the Interfacility Referral Process to the PICU. Pediatr Crit Care Med 2024; 25:571-573. [PMID: 38836711 DOI: 10.1097/pcc.0000000000003504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Affiliation(s)
- Jon Woods
- Both authors: Department of Pediatrics and Intermountain Primary Children's Hospital, Utah School of Medicine, Salt Lake City, UT
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Mahran GSK, Mahmoud Ahmed Mahmoud S, Abdelmowla RAA, Abdelmowla HAA, El-Aziz WWA, Mohamed SAA, Ali AFA. Developing an Operating Room-to-Intensive Care Unit Patient Handover Checklist: A Combined Quantitative and Qualitative Research Design. Crit Care Nurs Q 2024; 47:51-61. [PMID: 38031308 DOI: 10.1097/cnq.0000000000000491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
This article reports a study aimed at developing and validating an Operating Room-to-ICU Patient Handover checklist. Deficient or absent clinical handovers, or failures to transfer information, responsibility, and accountability can have unwanted consequences for hospitalized patients. Clinical handovers are practiced every day, in many ways, in all institutional health care settings. Despite increasing demand for structured processes to guide clinical handovers, standardized handover bundles for nurses and physicians are limited in the intensive care unit. As a result of this study an Operating Room-to-ICU Patient Handover checklist was created, which was based on a quantitative and qualitative research design. This checklist is expected to be helpful for proper patient transfers between these critical areas, ensuring patient safety and efficient quality management.
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Affiliation(s)
- Ghada Shalaby Khalaf Mahran
- Departments of Critical Care and Emergency Nursing (Drs Mahran and Mahmoud) and Medical Surgical Nursing (Drs R. A. A. Abdelmowla and H. A. A. Abdelmowla), Faculty of Nursing, Assiut University, Assiut, Egypt; Department of Critical Care and Emergency Nursing, Faculty of Nursing, Mansoura University, Mansoura, Egypt (Drs El-aziz and Ali); and Department of Chest Diseases and Tuberculosis, Faculty of Medicine, Assiut University, Assiut, Egypt, and Sultan Bin Abdulaziz Humanitarian City, Riyadh, Kingdom of Saudi Arabia (Dr Mohamed)
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Morrison JM, Casey B, Sochet AA, Dudas RA, Rehman M, Goldenberg NA, Ahumada L, Dees P. Performance Characteristics of a Machine-Learning Tool to Predict 7-Day Hospital Readmissions. Hosp Pediatr 2022; 12:824-832. [PMID: 36004542 DOI: 10.1542/hpeds.2022-006527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To develop an institutional machine-learning (ML) tool that utilizes demographic, socioeconomic, and medical information to stratify risk for 7-day readmission after hospital discharge; assess the validity and reliability of the tool; and demonstrate its discriminatory capacity to predict readmissions. PATIENTS AND METHODS We performed a combined single-center, cross-sectional, and prospective study of pediatric hospitalists assessing the face and content validity of the developed readmission ML tool. The cross-sectional analyses used data from questionnaire Likert scale responses regarding face and content validity. Prospectively, we compared the discriminatory capacity of provider readmission risk versus the ML tool to predict 7-day readmissions assessed via area under the receiver operating characteristic curve analyses. RESULTS Overall, 80% (15 of 20) of hospitalists reported being somewhat to very confident with their ability to accurately predict readmission risk; 53% reported that an ML tool would influence clinical decision-making (face validity). The ML tool variable exhibiting the highest content validity was history of previous 7-day readmission. Prospective provider assessment of risk of 413 discharges showed minimal agreement with the ML tool (κ = 0.104 [95% confidence interval 0.028-0.179]). Both provider gestalt and ML calculations poorly predicted 7-day readmissions (area under the receiver operating characteristic curve: 0.67 vs 0.52; P = .11). CONCLUSIONS An ML tool for predicting 7-day hospital readmissions after discharge from the general pediatric ward had limited face and content validity among pediatric hospitalists. Both provider and ML-based determinations of readmission risk were of limited discriminatory value. Before incorporating similar tools into real-time discharge planning, model calibration efforts are needed.
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Affiliation(s)
- John M Morrison
- Departments of Pediatrics.,Divisions of Pediatric Hospital Medicine
| | | | - Anthony A Sochet
- Anesthesia and Critical Care Medicine, Division of Pediatric Critical Care, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Pediatric Critical Care
| | - Robert A Dudas
- Departments of Pediatrics.,Divisions of Pediatric Hospital Medicine
| | - Mohamed Rehman
- Departments of Anesthesia, Pain, and Perioperative Medicine.,Pediatric Critical Care
| | - Neil A Goldenberg
- Departments of Pediatrics.,Pediatric Hematology, Johns Hopkins All Children's Hospital, St Petersburg, Florida
| | | | - Paola Dees
- Divisions of Pediatric Hospital Medicine
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Tortosa-Alted R, Martínez-Segura E, Berenguer-Poblet M, Reverté-Villarroya S. Handover of Critical Patients in Urgent Care and Emergency Settings: A Systematic Review of Validated Assessment Tools. J Clin Med 2021; 10:5736. [PMID: 34945032 PMCID: PMC8707112 DOI: 10.3390/jcm10245736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/30/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022] Open
Abstract
The emergency handover of critical patients is used to describe the moment when responsibility for the care of a patient is transferred from one critical patient care healthcare team to another, requiring the accurate delivery of information. However, the literature provides few validated assessment tools for the transfer of critical patients in urgent care and emergency settings. To identify the available evaluation tools that assess the handover of critical patients in urgent and emergency care settings in addition to evaluations of their psychometric properties, a systematic review was carried out using PubMed, Scopus, Cinahl, Web of Science (WoS), and PsycINFO, in accordance with PRISMA guidelines. The quality of the studies was assessed using the COSMIN checklist. Finally, eight articles were identified, of which only three included validated tools for evaluating the handover of critical patients in emergency care. Content validity, construct validity, and internal consistency were the most studied psychometric properties. Three studies evaluated error and reliability, criterion validity, hypothesis testing, and sensitivity. None of them considered cross-cultural adaptation or the translation process. This systematic psychometric review shows the existing ambiguities in the handover of critically ill patients and the scarcity of validated evaluation tools. For all of these reasons, we consider it necessary to further investigate urgent care and emergency handover settings through the design and validation of an assessment tool.
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Affiliation(s)
- Ruth Tortosa-Alted
- Hospital de Tortosa Verge de la Cinta, Catalan Institute of Health, Pere Virgili Institute, Carretera Esplanetes, 14, 43500 Tortosa, Spain; (R.T.-A.); (S.R.-V.)
- Nursing Department, Campus Terres de l’Ebre, Universitat Rovira i Virgili, Avenue Remolins, 13-15, 43500 Tortosa, Spain
| | - Estrella Martínez-Segura
- Hospital de Tortosa Verge de la Cinta, Catalan Institute of Health, Pere Virgili Institute, Carretera Esplanetes, 14, 43500 Tortosa, Spain; (R.T.-A.); (S.R.-V.)
- Nursing Department, Campus Terres de l’Ebre, Universitat Rovira i Virgili, Avenue Remolins, 13-15, 43500 Tortosa, Spain
| | - Marta Berenguer-Poblet
- Nursing Department, Campus Terres de l’Ebre, Universitat Rovira i Virgili, Avenue Remolins, 13-15, 43500 Tortosa, Spain
| | - Sílvia Reverté-Villarroya
- Hospital de Tortosa Verge de la Cinta, Catalan Institute of Health, Pere Virgili Institute, Carretera Esplanetes, 14, 43500 Tortosa, Spain; (R.T.-A.); (S.R.-V.)
- Nursing Department, Campus Terres de l’Ebre, Universitat Rovira i Virgili, Avenue Remolins, 13-15, 43500 Tortosa, Spain
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Lucrezia S, Noether J, Sochet AA. Standardized Work Rounds Enhance Teaming, Comprehensiveness, Shared Mental Model Development, and Achievement Rate of End-of-Shift Goals. Pediatr Crit Care Med 2021; 22:354-364. [PMID: 33258573 DOI: 10.1097/pcc.0000000000002609] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the impact of standardized PICU work rounds on the frequency of ideal teaming behaviors, rounds comprehensiveness, shared mental model index development, and rate of completed end-of-shift goals. DESIGN A single-center, pre-post, prospective cohort study. SETTING A 259-bed, quaternary, pediatric referral center. PATIENTS Children 0-18 years old from November 2018 to January 2020. INTERVENTIONS Standardized, bedside, nurse-led PICU work rounds, emphasizing ideal teaming behaviors using a collaboratively developed rounding script and quality/safety checklist. MEASUREMENTS AND MAIN RESULTS Study data were collected by direct observation and immediate postrounds participant questionnaire data. Primary outcomes were frequency of observed ideal teaming behaviors, rounds comprehensiveness, efficiency (rounds content divided by duration), shared mental model index (congruence among rounds participants regarding key healthcare data and planning), rounds face validity, and achievement rate of rounds-established, end-of-shift goals. During study, 154 encounters were observed (50 preintervention, 52 after Plan-Do-Study-Act cycle 1, and 52 after Plan-Do-Study-Act cycle 2). We observed improvements in overall shared mental model index (24-87%), rounds comprehensiveness (72-98%), and ideal teaming behaviors (including closed-loop communication: 82-100%; responsibility delegation: 74-100%; interdependence behaviors: 26-98%, all p < 0.01) by the end of study. Nursing presentations accounted for 3.6 ± 1.5 minutes of rounds and rounds duration was unchanged postintervention (11 ± 5 min preintervention and 11 ± 4 min after Plan-Do-Study-Act cycle 2, p > 0.99). Face validity, assessed using questionnaire data from 953 participants, revealed positive attitudes regarding efficiency, clarity, and participant self-value. Greatest enhancements in self-value were noted among advanced practice providers and respiratory therapists. On exploratory modeling, we noted associations between ideal teaming behaviors, rounds comprehensiveness, and shared mental model index. Similarly, we noted a positive association between the shared mental model index and the rate of achieved rounds-established, end-of-shift goals (odds ratio, 8.9; 95% CI, 1.7-46; p < 0.01). CONCLUSIONS Standardization of PICU work rounds may encourage ideal teaming behaviors, enhance rounds comprehensiveness, strengthen the congruence of participant shared mental model, and affect the rate of achieved goals established during rounds without compromising workplace efficiency.
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Affiliation(s)
- Samantha Lucrezia
- Department of Graduate Medical Education, Johns Hopkins All Children's Hospital, St. Petersburg, FL
| | - Julia Noether
- Division of Pediatric Critical Care Medicine, Department of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Anthony A Sochet
- Division of Pediatric Critical Care Medicine, Department of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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