Written by Kimiko Dunbar
Spoon Feed
A QI project with repeat assessment of high-risk patients by ED providers prior to inpatient transfer reduced advanced respiratory interventions, PICU upgrades within 24 hours, and rapid response team (RRT) activations.
Stable or not, here they come
Pediatric EDs are often inundated by patient volume and acuity, highlighted in the respiratory surge of 2022, with increasing patient volumes, ED boarding, and patients requiring PICU level care. Further, this surge was accompanied by an increase in patients requiring rapid transfer to the PICU after inpatient admission and RRT activations.
This quality improvement study investigated whether structured reevaluation and direct verbal handoffs of high-risk patients could reduce safety events during pediatric ED-to-inpatient transfers (see Figure 1). High-risk was defined as needing supplemental oxygen, nebs, magnesium, high-flow, non-invasive ventilation, or intubation, and patients were placed on a high-risk track board (HRTB). Using a pre-post design over 30 months at a tertiary center, transfer-related safety events significantly declined (53% to 32%, P = .01), especially serious events (13% to 2%, P = .005). Interventions also achieved a 53.1% decrease in advanced respiratory interventions (escalation to HFNC, non-invasive, or mechanical ventilation), 57.8% reduction in PICU upgrade within 24 hours of admission, and 59.8% reduction in RRT activations. Given that this is a QI study with multiple PDSA cycles, it’s impossible to know exactly which interventions lead to success. Further, this was conducted at a single institution with unique characteristics so may not be translatable elsewhere.
How does this change my practice?
This highlights the importance of intentional reassessment of high-risk patients and inclusion of bedside RNs. On more than one occasion I’ve been surprised by the acuity of a patient’s respiratory status when I walk in the room. While enforcing hospital-wide RN-clinician huddle is above my pay grade, I will be more thoughtful about identifying patients who require reassessment and include the bedside RN when I do.
Source
Improving the Safety of Pediatric Emergency Department to Inpatient Transfers of Care. Pediatrics. 2025 Jun 5:e2024068541. doi: 10.1542/peds.2024-068541. Epub ahead of print. PMID: 40467066
