I-PASS-to-PICU: A Structured Handoff Program to Improve Interfacility Referral Communication for PICU Transfer

OBJECTIVES: Interfacility transfers from frontline settings to the PICU can place children at risk for harm due to handoff miscommunication. We aimed to evaluate the effectiveness of a structured interfacility handoff program in improving communication between referring and receiving clinicians and across the PICU admitting team. DESIGN: Prospective intervention study using a mixed-methods approach (surveys, chart review, and semistructured interviews) before and after I-PASS-to-PICU implementation. SETTING: Academic tertiary referral PICU. PATIENTS: Children of 0-18 years old referred by external hospitals for urgent PICU admission. INTERVENTION: Structured handoff program (I-PASS-to-PICU) based on elements of high-quality handoffs adapted for interfacility PICU transfers. MEASUREMENTS AND MAIN RESULTS: A total of 220 patients were included (110 preintervention and 110 postintervention). Multivariable regression analysis adjusting for potential confounders showed no association between use of I-PASS-to-PICU and receiving PICU physician reports of key handoff information omissions (OR, 0.92; 95% CI, 0.30-2.82; p = 0.88 ). However, there was a decrease in the proportion of admitting PICU staff per patient who did not receive key handoff information (mean, 16% [ sd , 21%]; preintervention, 10% [ sd , 16%] vs. postintervention; p = 0.032). There were also more patients for whom receiving PICU physicians reported being well-prepared before admission (95% preintervention vs. 100% postintervention; p = 0.026). Postintervention, 94 patients (86%) had a completed I-PASS-to-PICU note; however, only a median of 50% (IQR, 34-66%) of admitting PICU staff per patient viewed the note before admission. Stakeholders identified barriers and facilitators of I-PASS-to-PICU implementation. CONCLUSIONS: A structured interfacility handoff program improved communication of key information across PICU admitting team members and increased reported preparedness of receiving PICU physicians. Identified barriers and facilitators of implementation can be used to inform, redesign, and adapt this program for uptake and use in other PICUs.