Inter-facility transfers into the pediatric intensive care unit (PICU) are high-risk transitions during which communication failures can increase the likelihood of patient harm. Referral calls that convey diagnostic information and the team’s diagnostic reasoning play a central role in creating a shared understanding between referring clinicians and receiving PICU teams. The I-PASS-to-PICU program was developed to standardize inter-facility handoffs and improve referral communication, but it was not explicitly designed to optimize the communication of diagnoses or diagnostic uncertainty.
Communication breakdowns during transfers have been associated with adverse outcomes in critically ill children. Prior work on handoff standardization suggests benefits for information transfer, yet tools adapted to inter-facility PICU referrals may not sufficiently address the diagnostic aspects of the handoff. This study explored whether the existing I-PASS-to-PICU structure facilitated discussion of diagnosis-relevant content during referral calls.
The study aimed to evaluate how well I-PASS-to-PICU supported inter-facility diagnostic handoffs, comparing diagnosis-related communication before and after program implementation using a mixed-methods review of audio-recorded referral calls to a single PICU.
Audio recordings of referral calls to one PICU were analyzed in a mixed-methods design. A total of 44 referral calls were reviewed, including 16 calls recorded before I-PASS-to-PICU implementation and 28 calls after implementation. Two pediatric intensivists, trained for the review, independently assessed whether diagnosis-relevant information or diagnostic activities were discussed in each call. Discrepancies between reviewers were resolved by consensus. In addition to structured presence/absence coding, reviewers provided qualitative observations about how diagnoses and diagnostic uncertainty were discussed and the effects on shared understanding.
Across the 44 calls reviewed, use of I-PASS-to-PICU did not produce statistically significant differences in the measured frequency of diagnosis-related communication when compared with unstructured handoffs. However, the reviewers observed absolute differences favoring calls using I-PASS-to-PICU in several specific measures:
These observed increases were not reported as statistically significant in the source.
Qualitative analysis of reviewers’ notes indicated that when primary diagnoses and diagnostic uncertainty were explicitly discussed, the referring and receiving teams were more likely to form a shared mental model of the patient’s condition. Reviewers highlighted that articulating both the presumed diagnosis and the degree of diagnostic certainty helped align expectations about the patient’s likely course and immediate needs. The qualitative data suggested that while I-PASS-to-PICU may encourage some diagnostic content, it does not consistently prompt explicit discussion of diagnostic uncertainty.
The study concludes that I-PASS-to-PICU may support aspects of the diagnostic handoff during inter-facility PICU transfers but is insufficient as currently implemented to ensure consistent discussion of diagnoses and diagnostic uncertainty. The authors recommend revising I-PASS-to-PICU to better facilitate diagnostic communication and then re-evaluating the tool’s impact on inter-facility diagnostic handoffs.
This was an exploratory, single-PICU study using a limited sample of audio-recorded calls (44 total). The source reports absolute differences in several diagnosis-related items but notes no statistically significant improvements attributable to I-PASS-to-PICU. The authors state that future work will focus on redesigning and testing I-PASS-to-PICU modifications specifically targeted to improve diagnostic handoffs during inter-facility PICU transfers.
(Study details, sample size, specific statistical analyses, and additional quantitative results beyond those reported above were not reported in the source.)