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The AAP Committee on Pediatric Emergency Medicine published a policy
statements on patient handoffs in 2016:
http://pediatrics.aappublications.org/content/pediatrics/138/5/e20162680.full.pdf

The statement is intentionally non-prescriptive, so you will not find an
answer to the debate about which is the best way to transition care of ED
patients to the PICU.  It is expected that each institution may have
different resources and needs that will guide the choice of the best method
for safe and effective handoffs.  There is a section that discusses
handoffs occurring from the ED to the Inpatient setting.

Important conceptual recommendations relevant to this discussion thread
include:

   - Handoffs should be structured and consistent
   - Handoffs should be patient- and family-centered
   - Trainees (i.e. residents and fellows) should receive education on
   handoff practices
   - All ED providers and staff should receive training on the handoff
   practice chosen by the institution

I think you might find the policy statement useful to open a dialogue with
your critical care colleagues.  In my experience, keeping the patient at
the center of the discussion while filling in feasibility constraints has
served me well.  I have also found that observing the handoffs of trainees
improves the process.

Toni Gross, MD, MPH, FAAP
Phoenix Children's Hospital

On Fri, Aug 11, 2017 at 6:10 PM, Michael S. Mitchell/Emergency Medicine <
[log in to unmask]> wrote:

> Thanks everyone for a spirited discussion.  Seems like there are some
> strong opinions out there and I value every one of them. I really
> appreciate it.
>
> It would seem that there's certainly not one BEST way to do this.  I think
> we all agree that a structured handoff to PICU is important, but HOW that
> happens is quite variable.
>
> I wish you the best in making it work for your department.
>
> Thanks again,
> Michael
>
> Michael S. Mitchell, MD
> Assistant Professor of Emergency Medicine
>
> Section of Pediatric Emergency Medicine
>
> Wake Forest University School of Medicine
>
> Medical Center Boulevard
>
> Winston-Salem, NC 27157
>
>
>
> ________________________________________
> From: Pediatric Emergency Medicine Discussion List [
> [log in to unmask]] on behalf of Shawn Robinson [
> [log in to unmask]]
> Sent: Friday, August 11, 2017 3:33 PM
> To: [log in to unmask]
> Subject: Re: Peds ED-PICU Handoff
>
> It seems that many of these policies/workflows/algorithms/tiers/etc are
> predicated on a learner having every patient in the ED. I struggle with
> this as I like to see patients on my own, without a resident. This is
> especially true when we have 4th year students (I'm not sending them for
> handoff). Should I leave the ED, and therefore all of the patients I am
> responsible for and the fellow supervision I am also responsible for, for
> at least 20 minutes? I actually had this same scenario yesterday when I had
> a PICU player without any resident at the end of my shift. I called and
> told the PICU the situation (talked to a different attending than who had
> accepted the admission and she knew very little of the story other than the
> diagnosis). She was understanding and agreed that there was no benefit from
> sending someone who did not see the patient, but wanted to make sure I knew
> "about the PICU handoff workflow." I reassured her that I knew about it and
> unless she was ready right then, I was not staying any longer past my shift.
>
> Interesting enough, when I work at the free standing, the requirement is
> only that I make the initial phone call for acceptance and not update at
> the time of transfer, even when sending by local ALS because critical care
> transport is not always available.
>
> There's probably a point somewhere in that rambling/venting.
>
> Thanks for listening
> Shawn Robinson
>
> Sent from my iPhone
>
> > On Aug 11, 2017, at 1:45 AM, Semple-Hess, Janet <[log in to unmask]>
> wrote:
> >
> > We have for many years had a fellow or resident accompany patient to
> PICU. Yes it slows things down for 15-20 minutes but none of us has
> questioned the value of this.
> >
> > Janet Semple-Hess
> > Children's Hospital Los Angeles
> >
> > Sent from my iPhone
> >
> >> On Aug 10, 2017, at 11:11, Michael S. Mitchell/Emergency Medicine <
> [log in to unmask]> wrote:
> >>
> >> Good afternoon.
> >>
> >> Our PICU physicians are asking that all PICU admissions from the ED
> have a bedside handoff in the PICU.  Basically, they want a senior
> resident/PEM fellow to escort the patient to the PICU (about 6-7 min away
> from the Peds ED) and then give a detailed hand-off (much like rounding) to
> a multi-disciplinary team in the PICU including RN, MD, and RT.
> >>
> >> Their request is incredibly costly for the peds ED as our residents and
> fellows are usually not expendable.
> >>
> >> Have other institutions tried this and found a way that it works?   We
> certainly see the benefit for that one single patient, but it comes at a
> cost of caring for the rest of the ED.
> >>
> >> Thanks in advance for any advice you can offer.
> >>
> >> Michael Mitchell, MD
> >> Medical Director-Pediatric ED
> >>
> >>
> >>
> >> Michael S. Mitchell, MD
> >> Assistant Professor of Emergency Medicine
> >>
> >> Section of Pediatric Emergency Medicine
> >>
> >> Wake Forest University School of Medicine
> >>
> >> Medical Center Boulevard
> >>
> >> Winston-Salem, NC 27157
> >>
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> >
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