P2A283: Patient- and Family-centered Outcomes During Inter-facility Transfer of Critically Ill Children to the Pediatric Intensive Care Unit

Background: The inter-facility transfer of a critically ill child from a frontline care setting to the pediatric intensive care unit (PICU) is stressful for families. Parents often travel to the PICU separate from their child, childcare for siblings may need to be arranged, and families have to navigate an unfamiliar hospital environment, all while contemplating the potential consequences of their child’s illness. Our objective was to generate consensus on a prioritized list of outcomes important to patients/families related to the inter-facility transfer of children to a higher level of care.

Methods: We conducted a consensus-based study at a single PICU using a modified Delphi method including 2 rounds of electronic/mailed surveys (completed) followed by semi-structured interviews (ongoing). Patients urgently transferred to the PICU from another institution and their parents/guardians were purposively sampled to include a diverse racial/ethnic/socio-economic cohort living at various geographic distances from the PICU. We compiled a list of inter-facility transfer-related patient- and family-centered outcomes (PFCOs) drawing on literature, practice guidelines, our prior work, and our experience as PICU clinicians. We included these PFCOs in the round I survey under 5 categories: patient/family understanding of need for transfer, communication with patient/family, family presence, patient needs, and family needs. The survey instrument was reviewed by a parent research partner and revised accordingly. Participants rated PFCOs on a 4-point Likert scale (1-unimportant to 4-very important). PFCOs rated as important/very important by 75% or more of participants and not rated as unimportant by any participant were retained for round II. PFCOs with opposing ratings were noted for further discussion at interviews.

Results: Twenty-six patient-parent dyads consented with 3 withdrawing before data collection. Patients had a median age of 2 (IQR 0.7-10) years and 57% had a chronic medical condition. Most patients were white (61%) and non-Hispanic (87%). Most (65%) lived in a zipcode area with a median household income of $50,000-$74,999/year (36th-52nd U.S. income percentile) and located a median of 73 (IQR 41-84) miles from the PICU. Round I surveys were completed by 13 (57%) and round II by 11 (48%) participants. After round I, 9 PFCOs were retained for round II. After round II, 2 PFCOs emerged as most important to families: 1) parents/guardians are informed about their child’s condition throughout transfer and 2) the patient can request for parents/guardians at any time during transfer (Table). Information from semi-structured interviews is pending.

Conclusion: The most important outcomes to families related to inter-facility transfers of critically ill children include keeping parents informed about their child’s condition and the child’s ability to request for parents throughout transfer. These PFCOs should be integrated into future work intending to improve the inter-facility transfer of critically ill children needing a higher level of care.