PC3064: Development and Evaluation of a Standard Electronic Referral Call Template to Improve Interfacility Communication Regarding Transfers to the Pediatric Intensive Care Unit

Purpose/Objectives: Transitions of care may involve miscommunication during patient handoffs, which puts critically ill children at risk for harm. Standardizing information exchange by adapting evidence-based handoff interventions to referral communication may prevent adverse events for children being transferred to the pediatric intensive care unit (PICU). Our objective was to develop and evaluate a standard electronic referral call template to improve verbal and written communication regarding patients being referred for PICU interfacility transfer.

Design/Methods: Using a human factors engineering approach, we iteratively developed and evaluated the feasibility and usability of a standard electronic referral call template in a single PICU (Figure). We created a clinical note template in the Epic electronic health record platform to be used in real time by PICU fellows (receives referral calls at our institution) as a guide for verbal communication and electronic documentation while receiving referral calls. We conducted interviews/focus groups to determine PICU stakeholders’ perspectives on the relevance of referral communication to their role, template information, template implementation, and measurement of impact. Qualitative data were audio-recorded, transcribed, coded, and analyzed for relevant themes. We then conducted usability testing with PICU fellows using 2 consecutive simulated referral calls per fellow. We directly observed template use noting problems encountered, administered the Systems Usability Scale (SUS) questionnaire to determine usability, and gathered qualitative feedback.

Results: We conducted 12 interviews and 4 focus groups with 21 total PICU staff (fellows, residents, nurse practitioners, nurses, respiratory therapists, and unit clerks). Staff universally indicated that detailed but concise information is crucial for admission preparedness. Identified barriers to referral communication included fellows’ time constraints and transmission of second-hand information. Majority indicated that a standard template with real-time electronic documentation may result in more direct and faster information transmission among PICU staff and improved preparedness. Staff noted that these benefits must be balanced with PICU fellow workload. Usability testing (Table) with 6 PICU fellows revealed good usability with a mean SUS score of 78 (SD 11). Referral calls were completed at a mean of 9 (SD 2.5) minutes. After the first call, an additional mean of 5.2 (SD 2.4) minutes were needed to complete and sign the electronic referral note, improving to 4.6 (SD 1.8) minutes with the second call. Difficulties in opening a new note and loading the correct template were resolved by the second call. Fellows identified redundant template fields that can be removed. All fellows indicated that the template was feasible and usable within the simulation; however, the template will need to be tested in real-time PICU practice.

Conclusion/Discussion: A standard electronic referral call template to improve interfacility communication regarding PICU transfers was technically feasible, usable, and relevant. Next steps include implementation and evaluation of the template in real-time PICU practice.