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Parikh NR, Francisco LS, Balikai SC, Luangrath MA, Elmore HR, Erdahl J, Badheka A, Chegondi M, Landrigan CP, Pennathur P, Reisinger HS, Cifra CL. Development and Evaluation of I-PASS-to-PICU: A Standard Electronic Template to Improve Referral Communication for Interfacility Transfers to the Pediatric ICU. Jt Comm J Qual Patient Saf 2024; 50:338-347. [PMID: 38418317 DOI: 10.1016/j.jcjq.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Miscommunication during interfacility handoffs to a higher level of care can harm critically ill children. Adapting evidence-based handoff interventions to interfacility referral communication may prevent adverse events. The objective of this project was to develop and evaluate a standard electronic referral template (I-PASS-to-PICU) to improve communication for interfacility pediatric ICU (PICU) transfers. METHODS I-PASS-to-PICU was iteratively developed in a single PICU. A core PICU stakeholder group collaboratively designed an electronic health record (EHR)-supported clinical note template by adapting elements from I-PASS, an evidence-based handoff program, to support information exchange between referring clinicians and receiving PICU physicians. I-PASS-to-PICU is a receiver-driven tool used by PICU physicians to guide verbal communication and electronic documentation during PICU transfer calls. The template underwent three cycles of iterative evaluation and redesign informed by individual and group interviews of multidisciplinary PICU staff, usability testing using simulated and actual referral calls, and debriefing with PICU physicians. RESULTS Individual and group interviews with 21 PICU staff members revealed that relevant, accurate, and concise information was needed for adequate admission preparedness. Time constraints and secondhand information transmission were identified as barriers. Usability testing with six receiving PICU physicians using simulated and actual calls revealed good usability on the validated System Usability Scale (SUS), with a mean score of 77.5 (standard deviation 10.9). Fellows indicated that most fields were relevant and that the template was feasible to use. CONCLUSION I-PASS-to-PICU was technically feasible, usable, and relevant. The authors plan to further evaluate its effectiveness in improving information exchange during real-time PICU practice.
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Good RJ, Boyer DL, Bjorklund AR, Corden MH, Harris MI, Tcharmtchi MH, Kink RJ, Koncicki ML, Molas-Torreblanca K, Miquel-Verges F, Mink RB, Rozenfeld RA, Sasser WC, Saunders S, Silberman AP, Srinivasan S, Tseng AS, Turner DA, Zurca AD, Czaja AS. Development of an Approach to Assessing Pediatric Fellows' Transport Medical Control Skills. Hosp Pediatr 2023:e2022007102. [PMID: 37376965 DOI: 10.1542/hpeds.2022-007102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
BACKGROUND AND OBJECTIVE Pediatric interfacility transport teams facilitate access to subspecialty care, and physicians often guide management remotely as transport medical control (TMC). Pediatric subspecialty fellows frequently perform TMC duties, but tools assessing competency are lacking. Our objective was to develop content validity for the items required to assess pediatric subspecialty fellows' TMC skills. METHODS We conducted a modified Delphi process among transport and fellow education experts in pediatric critical care medicine, pediatric emergency medicine, neonatal-perinatal medicine, and pediatric hospital medicine. The study team generated an initial list of items on the basis of a literature review and personal experience. A modified Delphi panel of transport experts was recruited to participate in 3 rounds of anonymous, online voting on the importance of the items using a 3-point Likert scale (marginal, important, essential). We defined consensus for inclusion as ≥80% agreement that an item was important/essential and consensus for exclusion as ≥80% agreement that an item was marginal. RESULTS The study team of 20 faculty drafted an initial list of items. Ten additional experts in each subspecialty served on the modified Delphi panel. Thirty-six items met the criteria for inclusion, with widespread agreement across subspecialties. Only 1 item, "discussed bed availability," met the criteria for inclusion among some subspecialties but not others. The study team consolidated the final list into 26 items for ease of use. CONCLUSIONS Through a consensus-based process among transport experts, we generated content validity for the items required to assess pediatric subspecialty fellows' TMC skills.
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Affiliation(s)
- Ryan J Good
- Section of Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
| | - Donald L Boyer
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ashley R Bjorklund
- Division of Pediatric Critical Care, University of Minnesota, Minneapolis, Minnesota
| | - Mark H Corden
- Division of Hospital Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Matthew I Harris
- Department of Pediatrics, Northwell Hofstra School of Medicine, New Hyde Park, New York
| | - M Hossein Tcharmtchi
- Section of Pediatric Critical Care, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Rudy J Kink
- Le Bonheur Children's Hospital, and University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee
| | - Monica L Koncicki
- Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, New York
| | - Kira Molas-Torreblanca
- Department of Pediatrics, University of California, Irvine, School of Medicine, Children's Hospital of Orange County, Orange, California
| | - Franscesca Miquel-Verges
- Division of Neonatology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Richard B Mink
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Ranna A Rozenfeld
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Hasbro Children's Hospital, Brown University, Providence, Rhode Island
| | - William C Sasser
- Division of Pediatric Critical Care Medicine, University of Alabama Birmingham, Birmingham, Alabama
| | - Scott Saunders
- School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Anna P Silberman
- Department of Pediatrics, Division of Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sushant Srinivasan
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ashlie S Tseng
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - David A Turner
- Competency-Based Medical Education, American Board of Pediatrics, Chapel Hill, North Carolina
- Division of Pediatric Critical Care, Department of Pediatrics, Duke University Hospital and Health System, Durham, North Carolina; and
| | - Adrian D Zurca
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Children's Hospital, Hershey, Pennsylvania
| | - Angela S Czaja
- Section of Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
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De Cloedt L, Jeffers J, Alix-Séguin L, Sauthier M, Tremblay-Roy JS, Pettersen G. Pediatric Interfacility Transport Curriculum: Its Impact on the Pediatric Intensive Care and Emergency Medicine Fellows' Performance and Confidence. Air Med J 2022; 41:442-446. [PMID: 36153140 DOI: 10.1016/j.amj.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/24/2022] [Accepted: 06/27/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Pediatric interfacility transports are frequent. Despite the absence of a formal pediatric transport curriculum in eastern Canada, directly managing patients during transport and medical direction of the referring center and transport team are part of the pediatric critical care medicine (PCCM) and pediatric emergency medicine (PEM) program requirements. The authors developed a pediatric interfacility transport curriculum and measured its impact on fellows' confidence and performance. METHODS This was a pilot interventional prospective study in Montreal, Canada. Postcurriculum surveys were used to measure confidence, and high-fidelity simulations were used to measure performance. A target threshold for confidence was defined before implementation, and pre- and post values were compared. The simulation scenario and assessment checklist were locally developed. RESULTS The participants were 11 PCCM and 3 PEM fellows. The content of the curriculum and educational methods were selected based on the literature and a needs assessment survey. All participants rated themselves as confident at the end of the curriculum. Eighty-three percent of the participants were deemed proficient with a perfect interrater agreement. CONCLUSION The pediatric transport curriculum had a positive impact on PEM and PCCM fellows' confidence and performance in transport. Further studies should look at the impact of such a curriculum on participants' real-life performance and patient care.
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Affiliation(s)
| | - Justin Jeffers
- Division of Pediatric Emergency Medicine, Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Laurence Alix-Séguin
- Department of Pediatric Emergency Medicine, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Quebec, Canada
| | - Michaël Sauthier
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Quebec, Canada
| | - Jean-Sébastien Tremblay-Roy
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Centre Hospitalier Universitaire de Sherbrooke, University of Sherbrooke, Sherbrooke, Canada
| | - Géraldine Pettersen
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, University of Montreal, Quebec, Canada.
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