Updates to referring clinicians regarding critically ill children admitted to the pediatric intensive care unit: a state-wide survey

Abstract

BackgroundFront-line clinicians are expected to make accurate and timely diagnostic decisions before transferring patients to the pediatric intensive care unit (PICU) but may not always learn their patients’ outcomes. We evaluated the characteristics of post-transfer updates received by referring clinicians regarding PICU patients and determined preferences regarding content, delivery, and timing of such updates.MethodsWe administered an electronic cross-sectional survey to Iowa clinicians who billed for ≥5 pediatric patients or referred ≥1 patient to the University of Iowa (UI) PICU in the year before survey administration.ResultsOne hundred and one clinicians (51 non-UI, 50 UI-affiliated) responded. Clinicians estimated that, on average, 8% of pediatric patients they saw over 1 year required PICU admission; clinicians received updates on 40% of patients. Seventy percent of UI clinicians obtained updates via self-initiated electronic record review, while 37% of non-UI clinicians relied on PICU communication (p = 0.013). Clinicians indicated that updates regarding diagnoses/outcomes will be most relevant to their practice. Among clinicians who received updates, 13% received unexpected information; 40% changed their practice as a result.ConclusionsClinicians received updates on less than half of the patients they referred to a PICU, although such updates could potentially influence clinical practice. Study findings will inform the development of a formal feedback system from the PICU to referring clinicians.

The Impact of a Multifaceted Simulation Education and Feedback Program for Community Emergency Departments on Pediatric Diabetic Ketoacidosis Management

“…Consistent formal feedback of patient management and outcomes to referring physicians is an important step to effect positive change in patient care. 33 The most effective feedback occurs when it is received from people who have developed relationships with referring hospitals and clinicians, fostering a culture of collaborative learning. 33 We have found that developing a relationship with hospitals before initiation of the feedback process has allowed us to be more successful with effecting change in practice management.…”

“…Hospitals may not be as receptive to feedback and may perceive feedback as criticism. Consistent formal feedback of patient management and outcomes to referring physicians is an important step to effect positive change in patient care 33 . The most effective feedback occurs when it is received from people who have developed relationships with referring hospitals and clinicians, fostering a culture of collaborative learning 33 .…”

Reporting Outcomes of Pediatric Intensive Care Unit Patients to Referring Physicians via an Electronic Health Record-Based Feedback System

“…We conducted two focus groups of ED physicians (six UI ED physicians and six non-UI-affiliated referring physicians) to substantiate our earlier survey indicating the gap in feedback 13 and explore physicians' perceptions of the relevance of receiving consistent patient outcome information. Referring physicians noted the various unsystematic ways in which they find out what happened to their patients.…”

“…Among clinicians who obtained feedback,13% received information they did not expect; 40% of these clinicians indicated that this experience changed their practice. 13…”

“…Among clinicians who obtained feedback,13% received information they did not expect; 40% of these clinicians indicated that this experience changed their practice. 13 Objectives Given this significant gap in feedback and its potential to improve the emergency care of critically ill children, our objective was to develop, implement, and evaluate a semiautomated electronic health record (EHR)-supported system at a single institution to deliver timely and relevant PICU patient outcome feedback to referring emergency department (ED) physicians. In this case study, we report the feasibility, usability, and relevance of the feedback system to both ED and PICU physicians.…”