Updates to referring clinicians regarding critically ill children admitted to the pediatric intensive care unit: a state-wide survey

Christina L. Cifra 1 , Cody R. Tigges 1 , Sarah L. Miller 2 , Loreen A. Herwaldt 3 , 4 , and Hardeep Singh 5
  • 1 Division of Pediatric Critical Care, Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, USA
  • 2 Department of Emergency Medicine, University of Iowa Carver College of Medicine, IA, Iowa City, USA
  • 3 Department of Internal Medicine, University of Iowa Carver College of Medicine, IA, Iowa City, USA
  • 4 Department of Epidemiology, University of Iowa College of Public Health, IA, Iowa City, USA
  • 5 Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, TX, Houston, USA
Christina L. Cifra
  • Corresponding author
  • Division of Pediatric Critical Care, Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, USA
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, Cody R. Tigges
  • Division of Pediatric Critical Care, Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, USA
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, Sarah L. Miller, Loreen A. Herwaldt
  • Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
  • Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
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and Hardeep Singh
  • Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA
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Abstract

Background

Front-line clinicians are expected to make accurate and timely diagnostic decisions before transferring patients to the pediatric intensive care unit (PICU) but may not always learn their patients’ outcomes. We evaluated the characteristics of post-transfer updates received by referring clinicians regarding PICU patients and determined preferences regarding content, delivery, and timing of such updates.

Methods

We administered an electronic cross-sectional survey to Iowa clinicians who billed for ≥5 pediatric patients or referred ≥1 patient to the University of Iowa (UI) PICU in the year before survey administration.

Results

One hundred and one clinicians (51 non-UI, 50 UI-affiliated) responded. Clinicians estimated that, on average, 8% of pediatric patients they saw over 1 year required PICU admission; clinicians received updates on 40% of patients. Seventy percent of UI clinicians obtained updates via self-initiated electronic record review, while 37% of non-UI clinicians relied on PICU communication (p = 0.013). Clinicians indicated that updates regarding diagnoses/outcomes will be most relevant to their practice. Among clinicians who received updates, 13% received unexpected information; 40% changed their practice as a result.

Conclusions

Clinicians received updates on less than half of the patients they referred to a PICU, although such updates could potentially influence clinical practice. Study findings will inform the development of a formal feedback system from the PICU to referring clinicians.

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