Perspectives on non-emergent neonatal intensive care unit to pediatric intensive care unit care transfers in the United States.

Abstract

Background: There is a substantial population of long-stay patients who non-emergently transfer directly from the neonatal intensive care unit (NICU) to the pediatric intensive care unit (PICU) without an interim discharge home. These infants are often medically complex and have higher mortality relative to NICU or PICU-only admissions. Given an absence of data surrounding practice patterns for non-emergent NICU to PICU transfers, we hypothesized that we would encounter a broad spectrum of current practices and a high proportion of dissatisfaction with current processes.

Aim: To characterize non-emergent NICU to PICU transfer practices across the United States and query PICU providers' evaluations of their effectiveness.

Methods: A cross-sectional survey was drafted, piloted, and sent to one physician representative from each of 115 PICUs across the United States based on membership in the PARK-PICU research consortium and membership in the Children's Hospital Association. The survey was administered via internet (REDCap). Analysis was performed using STATA, primarily consisting of descriptive statistics, though logistic regressions were run examining the relationship between specific transfer steps, hospital characteristics, and effectiveness of transfer.

Results: One PICU attending from each of 81 institutions in the United States completed the survey (overall 70% response rate). Over half (52%) indicated their hospital transfers patients without using set clinical criteria, and only 33% indicated that their hospital has a standardized protocol to facilitate non-emergent transfer. Fewer than half of respondents reported that their institution's non-emergent NICU to PICU transfer practices were effective for clinicians (47%) or patient families (38%). Respondents evaluated their centers' transfers as less effective when they lacked any transfer criteria (P = 0.027) or set transfer protocols (P = 0.007). Respondents overwhelmingly agreed that having set clinical criteria and standardized protocols for non-emergent transfer were important to the patient-family experience and patient safety.

Conclusion: Most hospitals lacked any clinical criteria or protocols for non-emergent NICU to PICU transfers. More positive perceptions of transfer effectiveness were found among those with set criteria and/or transfer protocols.