I. Khurana1, A. G. Antunez1, K. M. Zalewski1, K. Marchetti1, G. C. Ives1, S. K. Gadepalli1 1University Of Michigan,Pediatric Surgery,Ann Arbor, MI, USA
Introduction: Patient transfer to various areas within a hospital is a common yet high-risk activity that can result in morbidity. Mitigating risks involved by using various quality control measures can help reduce injuries; however, studies have predominantly focused on adult and inter-hospital transfers, with relatively little attention given to the more common intra-hospital transfer of pediatric patients. A systematic literature review was conducted to characterize adverse events (AE) encountered during intra-hospital transfers (IHT) of pediatric patients and to examine current quality control measures (QCM).
Methods: Studies investigating IHT of pediatric patients were found in the English-language literature of three databases (PubMed, Embase, and Web of Science), using the help of a medical librarian. We collected relevant outcome measures such as AE and QCM, along with study design and interventions used. Studies meeting inclusion criteria, based on two independent reviewers, were further categorized into the primary outcomes: AE identified and type of QCM. A Cohen’s unweighted kappa was used to determine inter-rater agreement.
Results: Of the initial 43 articles, 12 satisfied inclusion criteria, with a moderate inter-rater agreement on title/abstract review (k=0.54[0.34-0.74]). These studies focused on AE (5), QCM (1), or both (6) [see Table 1]. Only 6 of the 11 investigating AE and 2 of the 7 studies reporting QCM were prospective. A total of 1591 IHT were evaluated prospectively, with physiological deterioration accounting for 71% of reported AE, equipment failure 20%, and interventions required in 9%. These events mostly occurred during transfer between an intensive care unit and other parts of the hospital, and were related to extended duration of transport and sicker pre-transfer status of the patient (ventilation status, PRISM score). AE from human error can be remedied by teamwork and checklists to standardize QCM; while AE from disease processes can be improved by standardization of transfer protocols.
Conclusion: This review highlights the most common AE of pediatric IHT and suggests QCM to improve patient safety. Additional prospective studies to set threshold values for AE and to determine effectiveness of QCM should be conducted. This article impacts hospital policies and QCM used to benchmark and standardize pediatric IHT to reduce AE.
