title: Early identification of children at risk for critical care: standardizing communication for inter-emergency department transfers.
abstract: BACKGROUND
  Interfacility transfers occur frequently and often involve critically ill patients. Clear communication at the time of patient referral is essential for patient safety.
  
  
  OBJECTIVE
  The objective of this work was to study whether a standardized inter-emergency department (ED) transfer communication template for pediatric patients with respiratory complaints identifies patients that require intensive care unit (ICU) admission.
  
  
  METHODS
  We created a template to structure the communication between referring and receiving providers involved in inter-ED transfers of children with respiratory complaints. The template was designed for use by nonphysicians to prompt specific questions that would trigger notification of the ED attending based on signs of critical illness. The template was retrospectively applied to determine whether it would have properly triggered attending physician notification of a child ultimately requiring ICU admission.
  
  
  RESULTS
  Of 285 transferred children, 61 (21%) were admitted to an ICU from the receiving ED. The sensitivity of the communication template in predicting the need for ICU admission was 84% (95% confidence interval [CI], 72%-92%), negative predictive value of 95% (95% CI, 90%-97%), specificity of 77% (95% CI, 71%-82%), positive predictive value of 50% (95% CI, 40%-60%). Of the 10 patients admitted to an ICU who were not identified by the tool, none were critically ill upon arrival. Of the individual communication elements, the sensitivity and negative predictive value ranged from 3% to 38% and from 79% to 86%, respectively.
  
  
  CONCLUSIONS
  A standardized communication template for inter-ED transfers can identify children with respiratory complaints who require ICU admission. Next steps include real-time application to judge screening performance compared with current nonstandardized intake protocols.
authors.affiliation: Division of Emergency Medicine, Department of Anesthesia, Boston Children's Hospital, Boston, MA, USA. cs2476@columbia.edu
authors.forename: Cyril
authors.initials: C
authors.lastname: Sahyoun
authors.forename: Eric
authors.initials: E
authors.lastname: Fleegler
authors.forename: Monica
authors.initials: M
authors.lastname: Kleinman
authors.forename: Michael C
authors.initials: MC
authors.lastname: Monuteaux
authors.forename: Richard
authors.initials: R
authors.lastname: Bachur
mesh_terms: D002675:Child, Preschool; D003422:Critical Care; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006748:Hospital Departments; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D033183:Interdisciplinary Communication; D010343:Patient Admission / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012140:Respiratory Tract Diseases / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D012306:Risk; D018570:Risk Assessment / Q000379:methods*