Interfacility Transfer of Pediatric Patients to a Comprehensive Children's Hospital

Practice Problem: Secondary transfers to pediatric centers have increased by 25% due to the regionalization of specialty care. Low pediatric volume and the lack of access to pediatric subspecialty confounds the need for transfer requests to comprehensive children’s hospitals. Referring hospitals rely on pediatric teams to determine the level of service and mode of transportation decisions due to a lack of comfort in caring for and managing pediatric patients. PICOT: This project was guided by the following question. In pediatric patients transferring from other healthcare facilities to a comprehensive children’s hospital (P), does the implementation of a nurse-led pediatric illness severity scoring tool (I) versus traditional phone triage (C), increase recognition and notification of ICU level patients (O) in 8-weeks (T)? Evidence: Triage transport tools have been studied in the pediatric population and are relied on to determine acuity and predict admission needs. Acuity tools allow for consistent resource allocation and improved transfers by removing the subjectiveness of physical findings and converting the assessments into objective metrics needed to make safe transport and admission decisions. Intervention: A pediatric transport acuity tool was implemented to standardize the reporting framework and was scored to identify high-acuity patients requiring transport for definitive care. Outcome: Improved identification of ICU-level patients requiring transport to a pediatric hospital from 63% pre-intervention to 97% post-intervention. Conclusion: This project increased recognition of ICU-level pediatric patients through use of the TRAP tool and also identified a broader impact, which is exposing referring hospitals to a triage tool that assists outside providers in identifying acutely ill pediatric patients.