---
title: "I-PASS-to-PICU and diagnostic handoffs for inter-facility pediatric ICU transfers"
id: "pubmed-42763795"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42763795"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42763795/"
doi: "10.1515/dx-2026-0083"
published_at: "2026-09-21T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# I-PASS-to-PICU and diagnostic handoffs for inter-facility pediatric ICU transfers
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42763795
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42763795/)
- **DOI:** [10.1515/dx-2026-0083](https://doi.org/10.1515%2Fdx-2026-0083)
- **Published At:** 2026-09-21T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Inter-facility transfers to the **pediatric intensive care unit (PICU)** carry increased risk of harm from communication breakdowns, particularly around diagnosis-related information. - The team previously developed **I-PASS-to-PICU**, a structured inter-facility handoff program aimed at improving referral communication for PICU transfers; it was not specifically designed to optimize **diagnostic handoffs**. - This exploratory mixed-methods study analyzed audio-recorded referral calls to one PICU before and after implementation of I-PASS-to-PICU to evaluate how well it facilitated diagnosis-related communication. - Two pediatric intensivists reviewed 44 calls (16 pre-implementation, 28 post-implementation) and flagged presence of diagnosis-relevant information or activities; disagreements were resolved by consensus. Reviewers also recorded qualitative observations. - Quantitatively, use of I-PASS-to-PICU did not produce statistically significant differences in the frequency of diagnosis-related communications compared with unstructured calls. - Absolute increases were noted post-implementation: discussions of illness severity (75% vs 50%), the primary diagnosis stated by the referring clinician (68% vs 44%) and by the receiving PICU physician (39% vs 25%). - Qualitative findings indicated that when primary diagnoses and diagnostic uncertainty were discussed, clinicians more effectively formed shared mental models of the patient’s condition. - The authors conclude that I-PASS-to-PICU may support some elements of inter-facility **diagnostic handoff** but requires revision to reliably prompt discussion of diagnoses and diagnostic uncertainty. - Future work will focus on redesigning and evaluating I-PASS-to-PICU specifically to improve diagnostic handoffs during inter-facility PICU transfers.
## Clinical Analysis & Structured Key Points
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Online ahead of print. # Diagnosis-related handoffs for inter-facility transfers to the pediatric intensive care unit [Irene Pantekidis](https://pubmed.ncbi.nlm.nih.gov/?term=Pantekidis+I&cauthor_id=42763795)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42763795/#full-view-affiliation-1 "Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA."), [Poornima Pandiyan](https://pubmed.ncbi.nlm.nih.gov/?term=Pandiyan+P&cauthor_id=42763795)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42763795/#full-view-affiliation-2 "Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA."), [Hardeep Singh](https://pubmed.ncbi.nlm.nih.gov/?term=Singh+H&cauthor_id=42763795)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42763795/#full-view-affiliation-3 "Safety, Quality and Well-Being Institute at Houston Methodist, Houston, Texas, USA."), [Christopher P Landrigan](https://pubmed.ncbi.nlm.nih.gov/?term=Landrigan+CP&cauthor_id=42763795)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42763795/#full-view-affiliation-4 "Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42763795/#full-view-affiliation-5 "Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA."), [Christina L Cifra](https://pubmed.ncbi.nlm.nih.gov/?term=Cifra+CL&cauthor_id=42763795)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42763795/#full-view-affiliation-2 "Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.") Affiliations Expand ### Affiliations * 1 Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA. * 2 Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. * 3 Safety, Quality and Well-Being Institute at Houston Methodist, Houston, Texas, USA. * 4 Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. * 5 Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. * PMID: **42763795** * DOI: [ 10.1515/dx-2026-0083 ](https://doi.org/10.1515/dx-2026-0083) Item in Clipboard # Diagnosis-related handoffs for inter-facility transfers to the pediatric intensive care unit Irene Pantekidis et al. Diagnosis (Berl). 2026. Show details Display options Display options Format Abstract PubMed PMID Diagnosis (Berl) Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Diagnosis+%28Berl%29%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Diagnosis+%28Berl%29%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42763795/) . 2026 Sep 21. doi: 10.1515/dx-2026-0083. Online ahead of print. ### Authors [Irene Pantekidis](https://pubmed.ncbi.nlm.nih.gov/?term=Pantekidis+I&cauthor_id=42763795)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42763795/#short-view-affiliation-1 "Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA."), [Poornima Pandiyan](https://pubmed.ncbi.nlm.nih.gov/?term=Pandiyan+P&cauthor_id=42763795)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42763795/#short-view-affiliation-2 "Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA."), [Hardeep Singh](https://pubmed.ncbi.nlm.nih.gov/?term=Singh+H&cauthor_id=42763795)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42763795/#short-view-affiliation-3 "Safety, Quality and Well-Being Institute at Houston Methodist, Houston, Texas, USA."), [Christopher P Landrigan](https://pubmed.ncbi.nlm.nih.gov/?term=Landrigan+CP&cauthor_id=42763795)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42763795/#short-view-affiliation-4 "Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.")[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42763795/#short-view-affiliation-5 "Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA."), [Christina L Cifra](https://pubmed.ncbi.nlm.nih.gov/?term=Cifra+CL&cauthor_id=42763795)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42763795/#short-view-affiliation-2 "Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.") ### Affiliations * 1 Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA. * 2 Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. * 3 Safety, Quality and Well-Being Institute at Houston Methodist, Houston, Texas, USA. * 4 Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. * 5 Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. * PMID: **42763795** * DOI: [ 10.1515/dx-2026-0083 ](https://doi.org/10.1515/dx-2026-0083) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Objectives:** Inter-facility transfers to the pediatric intensive care unit (PICU) increase the risk of patient harm from communication breakdowns. We previously developed I-PASS-to-PICU, a structured inter-facility handoff program to improve information exchange during these transitions. However, it was not designed to optimize communication related to diagnosis (diagnostic handoff). This exploratory study evaluated how well I-PASS-to-PICU facilitated inter-facility diagnostic handoffs. **Methods:** Using mixed methods, we analyzed audio-recorded referral calls to a single PICU to characterize inter-facility diagnostic handoff communication before and after I-PASS-to-PICU implementation. Two pediatric intensivists trained to review calls indicated whether diagnosis-relevant information or activities were discussed. Discrepancies in review were resolved via consensus. Reviewers also provided qualitative observations on diagnosis-related discussions. **Results:** Forty-four referral calls were reviewed (16 pre-and 28 post-I-PASS-to-PICU implementation). Compared with unstructured handoffs, I-PASS-to-PICU use did not result in statistically significant differences in the communication of diagnosis-related information in inter-facility handoffs. However, we observed some absolute differences; there were more calls using I-PASS-to-PICU in which illness severity was discussed (75 % vs. 50 %) and the primary diagnosis was stated by the referring clinician (68 % vs. 44 %) or receiving PICU physician (39 % vs. 25 %). Qualitative analysis revealed that shared mental models were more effectively created when primary diagnoses and diagnostic uncertainty were discussed. **Conclusions:** I-PASS-to-PICU may support aspects of the inter-facility diagnostic handoff but needs further revision to facilitate consistent discussion of diagnoses and diagnostic uncertainty. Future work will focus on redesigning and evaluating I-PASS-to-PICU for improving the diagnostic handoff during inter-facility PICU transfers. **Keywords:** communication; critical care; diagnostic errors; patient handoff; patient safety; pediatrics. © 2026 Walter de Gruyter GmbH, Berlin/Boston. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Similar articles * [ Development and Evaluation of I-PASS-to-PICU: A Standard Electronic Template to Improve Referral Communication for Interfacility Transfers to the Pediatric ICU. ](https://pubmed.ncbi.nlm.nih.gov/38418317/) Parikh NR, Francisco LS, Balikai SC, Luangrath MA, Elmore HR, Erdahl J, Badheka A, Chegondi M, Landrigan CP, Pennathur P, Reisinger HS, Cifra CL.Parikh NR, et al.Jt Comm J Qual Patient Saf. 2024 May;50(5):338-347. doi: 10.1016/j.jcjq.2024.01.010. Epub 2024 Jan 24.Jt Comm J Qual Patient Saf. 2024.PMID: 38418317Free PMC article. * [ Interfacility Transfer and Admission to PICUs in the United States: Survey of Referral Communications in 2023. ](https://pubmed.ncbi.nlm.nih.gov/39918372/) Cifra CL, Lin O, Gonzales CL, Pantekidis I, Chegondi M, Graciano AL, Gradidge E, Malone MP, Marx MHM, Parikh NR, Woods-Hill CZ, Landrigan CP; Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network.Cifra CL, et al.Pediatr Crit Care Med. 2025 May 1;26(5):e669-e679. doi: 10.1097/PCC.0000000000003702. Epub 2025 Feb 7.Pediatr Crit Care Med. 2025.PMID: 39918372Free PMC article. * [ Improving Patient Handoffs and Transitions through Adaptation and Implementation of I-PASS Across Multiple Handoff Settings. ](https://pubmed.ncbi.nlm.nih.gov/32766496/) Blazin LJ, Sitthi-Amorn J, Hoffman JM, Burlison JD.Blazin LJ, et al.Pediatr Qual Saf. 2020 Jul 23;5(4):e323. doi: 10.1097/pq9.0000000000000323. eCollection 2020 Jul-Aug.Pediatr Qual Saf. 2020.PMID: 32766496Free PMC article. * [ Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas. ](https://pubmed.ncbi.nlm.nih.gov/36321557/) Crider K, Williams J, Qi YP, Gutman J, Yeung L, Mai C, Finkelstain J, Mehta S, Pons-Duran C, Menéndez C, Moraleda C, Rogers L, Daniels K, Green P.Crider K, et al.Cochrane Database Syst Rev. 2022 Feb 1;2(2022):CD014217. doi: 10.1002/14651858.CD014217.Cochrane Database Syst Rev. 2022.Update in: [Cochrane Database Syst Rev. 2026 Feb 18;2:CD014217. doi: 10.1002/14651858.CD014217.pub2.](https://pubmed.ncbi.nlm.nih.gov/41705996/)PMID: 36321557Free PMC article.Updated. * [ The Effectiveness of Standardized Handoff Tool Interventions During Inter- and Intra-facility Care Transitions on Patient-Related Outcomes: A Systematic Review. ](https://pubmed.ncbi.nlm.nih.gov/28467104/) Rosenthal JL, Doiron R, Haynes SC, Daniels B, Li ST.Rosenthal JL, et al.Am J Med Qual. 2018 Mar/Apr;33(2):193-206. doi: 10.1177/1062860617708244. Epub 2017 May 3.Am J Med Qual. 2018.PMID: 28467104 [ See all similar articles ](https://pubmed.ncbi.nlm.nih.gov/?linkname=pubmed_pubmed&from_uid=42763795) ## References 1. 1. Noje, C, Costabile, PM, Henderson, E, O’Donnell, E, Bhatia, P, Singh, S, et al.. Diagnostic discordance in pediatric critical care transport: a single-center experience. Pediatr Emerg Care 2021;37:e1616–22. . - [DOI](https://doi.org/10.1097/pec.0000000000002135) 2. 1. Usher, MG, Fanning, C, Wu, D, Muglia, C, Balonze, K, Kim, D, et al.. Information handoff and outcomes of critically ill patients transferred between hospitals. J Crit Care 2016;36:240–5. . - [DOI](https://doi.org/10.1016/j.jcrc.2016.08.006) 3. 1. Gausche-Hill, M, Ely, M, Schmuhl, P, Telford, R, Remick, KE, Edgerton, EA, et al.. A national assessment of pediatric readiness of emergency departments. JAMA Pediatr 2015;169:527–34. . - [DOI](https://doi.org/10.1001/jamapediatrics.2015.138) 4. 1. Thirnbeck, CK, Espinoza, ET, Beaman, EA, Rozen, AL, Dukes, KC, Singh, H, et al.. Interfacility referral communication for PICU transfer. Pediatr Crit Care Med 2024;25:499–511. . - [DOI](https://doi.org/10.1097/pcc.0000000000003479) 5. 1. Cifra, C, Farag, R, Dukes, K, Gomez, R, Holland, I, Rouse, E, et al.. Ethnography of a diagnostic process handoff: referral communication for pediatric intensive care unit admission and the diagnosis of critically ill children In: Society to improve diagnosis in medicine conference 2023 . Cleveland, OH; 2023. 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