title: Quality improvement and patient care checklists in intrahospital transfers involving pediatric surgery patients.
abstract: BACKGROUND
  Intrahospital transfers are necessary but hazardous aspects of pediatric surgical care. Plan-Do-Study-Act processes identify risks during hospitalization and improve care systems and patient safety.
  
  
  METHODS
  A multidisciplinary team developed a checklist that documented patient data and handoffs for all intrahospital transfers involving pediatric surgical inpatients. The checklist summarized major clinical events and provided concurrent summaries by 3-month quarters (Q) over 1 year.
  
  
  RESULTS
  There were 903 intrahospital transfers involving 583 inpatients undergoing surgery. Total handoffs were documented in 436 (75% of 583), with greater than 1 handoff in 202 (46% of 436). Documented problems occurred in 31 transfers (3.4%), the most during Q1 (19/191; 9.9%). Incidence fell to 3.5% (9/260) in Q2, 0.4% (1/243) in Q3, and 1.0% (2/209) in Q4 (P < .001). Patient care issues (14/31; 45%) were most common, followed by documentation (10, 32%) and process problems (7, 23%). The quality improvement team was able to resolve patient instability during transport (5 in Q1, none in Q3, Q4) and poor pain control (3 in Q2, 1 in Q3, Q4). Of the patients, 3.2% had identified problems with patient care during intrahospital transfer.
  
  
  CONCLUSIONS
  Plan-Do-Study-Act review emphasizes ongoing process analysis by multidisciplinary teams. Checklists reinforce communication and provide feedback on whether system goals are being achieved.
authors.affiliation: Department of Surgery, Mercer University School of Medicine and Medical Center of Central Georgia, Macon, GA 31201, USA. Nakayama.Don@mccg.org
authors.forename: Don K
authors.initials: DK
authors.lastname: Nakayama
authors.forename: Sally S
authors.initials: SS
authors.lastname: Lester
authors.forename: Darla R
authors.initials: DR
authors.lastname: Rich
authors.forename: Bryan C
authors.initials: BC
authors.lastname: Weidner
authors.forename: Joshua B
authors.initials: JB
authors.lastname: Glenn
authors.forename: Issam J
authors.initials: IJ
authors.lastname: Shaker
mesh_terms: D057189:Checklist; D002648:Child; D006801:Humans; D010360:Patient Transfer / Q000592:standards*; D058996:Quality Improvement / Q000592:standards*; D013514:Surgical Procedures, Operative