Characterization of Potentially Avoidable Pediatric Intensive Care Unit Transfers.

Abstract

Background and objective: Rapid response systems (RRSs) assess and transfer patients from general care units to the pediatric intensive care unit (PICU) and are necessary to safely care for hospitalized patients. A proportion of patients who transfer to the PICU do not receive PICU-specific care and may be considered potentially avoidable transfers (PATs). The objective of this study is to describe and characterize PATs at a quaternary free-standing children's hospital.

Patients and methods: Reasons for RRS activation were collected using a prospective survey at the time of RRS activation. Retrospective chart review was conducted on PICU transfers to determine if they met criteria for PAT. PATs were identified if the patient did not experience a critical deterioration event, could not be classified as an emergent transfer, or did not undergo any PICU-specific interventions.

Results: Nearly half (110/255; 43%) of transfers to the PICU via RRS were classified as PATs. Median time from admission to transfer was 32 hours (interquartile range 13.2-99.4) with a median age of 6 years (interquartile range 1.52-14.74). PATs most commonly came from the general pediatrics unit (33%). The most common reason for transfer for PATs was respiratory distress.

Conclusions: PATs made up nearly half of transfers from the general care unit to the PICU. We propose that PATs can be considered a balancing metric in the assessment of RRSs, especially as inpatient pediatric care is becoming increasingly limited.