{
    "abstract": "Poor communication during interfacility transfer to the PICU can harm critically ill children. Structured handoff communication can prevent harm; however, the landscape of interfacility referral communication practices across PICUs is unknown. Our objective was to describe interfacility referral communication practices among U.S. PICUs to begin identifying potential improvement opportunities.\nMixed methods study including a cross-sectional survey and semi-structured interviews.\nU.S. PICUs with greater than or equal to 10 beds in 2023.\nClinical/administrative PICU leaders.\nNone.\nSixty surveys with greater than 70% completed questions were returned from 170 invited participants (35% response rate). Respondents were mainly pediatric critical care medicine division chiefs (48%) or PICU medical directors (32%). PICUs in all U.S. continental regions were represented, which had a median of 1200 (interquartile range [IQR], 1000-1500) admissions per year, of which 29.5% (IQR, 15-39%) were patients directly transferred from other institutions. In 93% of PICUs, a verbal interfacility handoff occurs between the referring clinician and a PICU physician; however, only 24% were always guided by a standard communication tool. In 72% of PICUs, medical records were only sometimes available before patient arrival. Semi-structured interviews with seven volunteer respondents revealed the following themes: 1) standardizing communication can result in organized and efficient handoffs but may also result in inefficiencies, 2) trained staff dedicated to interfacility referrals will improve communication quality, 3) integration of handoff information into the electronic health record will improve dissemination and decrease PICU physicians' workload, and 4) implementing a structured process will require staff support to change current workflows.\nReferral communication for interfacility patient transfers to the PICU occurred mainly through unstructured verbal handoffs between referring clinicians and PICU physicians. PICU leaders identified several potential benefits and challenges of standardizing interfacility referral communication.",
    "authors": [
        {
            "affiliation": "Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA.\nDivision of Pediatric Critical Care Medicine, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA.",
            "firstname": "Christina L",
            "initials": "CL",
            "lastname": "Cifra"
        },
        {
            "affiliation": "Harvard College, Harvard University, Boston, MA.",
            "firstname": "Olivia",
            "initials": "O",
            "lastname": "Lin"
        },
        {
            "affiliation": "Northeastern University, Boston, MA.",
            "firstname": "Celestine L",
            "initials": "CL",
            "lastname": "Gonzales"
        },
        {
            "affiliation": "Division of Medical Critical Care, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA.",
            "firstname": "Irene",
            "initials": "I",
            "lastname": "Pantekidis"
        },
        {
            "affiliation": "Division of Pediatric Critical Care Medicine, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA.\nDivision of Pediatric Critical Care Medicine, University of Illinois College of Medicine at Peoria and OSF HealthCare Children's Hospital of Illinois, Peoria, IL.",
            "firstname": "Madhuradhar",
            "initials": "M",
            "lastname": "Chegondi"
        },
        {
            "affiliation": "Division of Critical Care Medicine, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD.",
            "firstname": "Ana Lia",
            "initials": "AL",
            "lastname": "Graciano"
        },
        {
            "affiliation": "Division of Critical Care, Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE.",
            "firstname": "Eleanor",
            "initials": "E",
            "lastname": "Gradidge"
        },
        {
            "affiliation": "Division of Critical Care Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR.",
            "firstname": "Matthew P",
            "initials": "MP",
            "lastname": "Malone"
        },
        {
            "affiliation": "Division of Pediatric Critical Care, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH.",
            "firstname": "Matthew H M",
            "initials": "MHM",
            "lastname": "Marx"
        },
        {
            "affiliation": "Division of Pediatric Critical Care Medicine, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA.",
            "firstname": "Nehal R",
            "initials": "NR",
            "lastname": "Parikh"
        },
        {
            "affiliation": "Division of Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.",
            "firstname": "Charlotte Z",
            "initials": "CZ",
            "lastname": "Woods-Hill"
        },
        {
            "affiliation": "Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA.\nDivision of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.",
            "firstname": "Christopher P",
            "initials": "CP",
            "lastname": "Landrigan"
        },
        {
            "affiliation": null,
            "firstname": null,
            "initials": null,
            "lastname": null
        }
    ],
    "conclusions": null,
    "copyrights": "Copyright \u00a9 2025 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.",
    "doi": "10.1097/PCC.0000000000003702",
    "journal": "Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies",
    "keywords": [],
    "methods": null,
    "publication_date": "2025-02-07",
    "pubmed_id": "39918372",
    "results": null,
    "title": "Interfacility Transfer and Admission to PICUs in the United States: Survey of Referral Communications in 2023.",
    "xml": "<Element 'PubmedArticle' at 0x7885042ed710>"
}