Improving Pediatric Transitions of Care Between an Interfacility Transport Team and Inpatient Units

Background: Handoff communication is a high risk time in which pertinent patient and care plan information is passed between caregivers (The Joint Commission, 2017). Inadequate hand-off communication is considered a sentinel event by The Joint Commission due to the ramifications it can have in the quality of patient care and outcomes (2017). Handoff communication is important in all transitions of care, whether it is from shift to shift, from one care team to another, or one facility to another (Thorpe, 2012). Written tools have shown effective in improving handoff communication between care providers and in transitions from care teams (Genovesi, 2017). Effective handoff strategies incorporate: interactive communication, limitation of interruptions, verification of information, and review of relevant and historical information (American College of Obstetricians and Gynecologists, 2012). Strategies to effectively improve handoff communication include: standardization, assessment of risk, education, and leadership commitment (Association of Perioperative Registered Nurses, 2017).

A pediatric interfacility transport team within a midwestern hospital system recognized an opportunity to improve patient care for pediatric patients admitted to the general floor when increasing rates of rapid responses were being called within 12 hours of admission via the transport team as well as an increase in the number of transfers to the pediatric intensive care unit (PICU) within the same timeframe. The transport team, transport medical control physicians, and inpatient care teams worked together to devise a plan to improve detection of patients with a greater likelihood of clinical deterioration and ensure best communication practices between the care teams.

Methods: The pediatric interfacility transport team aimed to align with pediatric care practices across the children's hospital by calculating children's hospital early warning scores (CHEWs) on all patients who are to be admitted to the pediatric floors. CHEWs are used as an objective way to evaluate patient condition and detect propensity for clinical deterioration (). The transport team then constructed a transition of care plan based upon the patient's CHEWs. With increasing CHEWs, more members of the care team become involved in admission report due to the increasing likelihood of clinical deterioration as well as the need for more timely treatment to prevent deterioration.

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