Print

Print


Hi everyone,

At CHOP, in the past, all ED-PICU admissions went through the same admission process: an ED practitioner (resident, fellow, nurse practitioner) called the PICU admit fellow who accepted the patient, arranged for a bed, and notified PICU nursing staff. Verbal hand-off would occur via telephone conversation on several levels – ED resident/fellow/NP to PICU fellow/resident, ED nurse to PICU nurse, ED RT to PICU RT. 

In 2012, we implemented a Tier System for ED-PICU admissions. The purpose of this system was manifold: to expedite admission of critically ill patients, have a system by which the ED could ask for immediate PICU assistance in resuscitating a patient, to streamline communication, improve hand-offs, and improve teamwork between both departments. Below is a brief summary of the Tiers:

Tier 1: PICU to ED STAT to assist with patient care, verbal hand-off in ED, PICU team takes patient to PICU
Tier 2: ED has stabilized patient, ED attending to PICU attending phone conversation, PICU makes bed ready within 2 hours, ED team takes patient to PICU, verbal hand-off in PICU
Routine admission: process outlined above

For the Tier 2s, the most knowledgeable physician/practitioner goes with the patient - most often the ED fellow, but it can be the ED resident or NP if no fellow is available. 

When we looked at the 2015-2016 admissions, the Tier 1 patients had a median ED LOS of 79 min and Tier 2 had 149 min. We also conducted a survey of both PICU and ED staff and found that the Tier 1 was very well regarded by both departments. The Tier System has several kinks (specifically regarding Tier 2) and we continue to try to improve upon it. I am happy to answer any more questions about our process. Please feel free to email me.

Jeannine Del Pizzo, MD
The Children’s Hospital of Philadelphia


> On Aug 10, 2017, at 4:30 PM, G Ruben <[log in to unmask]> wrote:
> 
> Might there be a middle ground here. Why not suggest using telemedicine technology to have voice, face to face video, and telemetry data available to both the PED and PICU attending and any trainees involved to discuss the case as the patient is about to leave the PED or just arrives in the PICU. Actually, if it is not already being done, it could then be adapted in interfacility transfers of the same nature. 
> 
> Just a thought (which, now that I think of it, I will suggest for our more serious transfers from our community teaching hospital to the nearby children's hospital). Seems like a very good way to reduce error and preserve everyone's time. And it is off the shelf technology. 
> 
> Regards, 
> Geoff 
> 
> 
> Geoffrey L. Ruben, MD, MMM, FACEP, FAAP 
> 
> 
> ----- Original Message -----
> 
> From: "Adam Vukovic" <[log in to unmask]> 
> To: [log in to unmask] 
> Sent: Thursday, August 10, 2017 3:03:41 PM 
> Subject: Re: Peds ED-PICU Handoff 
> 
> We also use it in Nashville and it generally is a non-issue. Becomes a little more problematic when said resident is performing a procedure.... but overall works fine. 
> 
>> On Aug 10, 2017, at 1:29 PM, Halim Hennes <[log in to unmask]> wrote: 
>> 
>> We have it in Dallas and have been doing it for years. Works well and good for patient care. Minimal impact on ED workflow 
>> 
>> Halim 
>> Sent from my iPhone 
>> 
>> On Aug 10, 2017, at 2:10 PM, 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 
>> 
>> For more information, send mail to [log in to unmask] with the message: info PED-EM-L 
>> The URL for the PED-EM-L Web Page is: 
>> http://listserv.brown.edu/ped-em-l.html 
>> 
>> ________________________________ 
>> 
>> UT Southwestern 
>> 
>> 
>> Medical Center 
>> 
>> 
>> 
>> The future of medicine, today. 
>> 
>> For more information, send mail to [log in to unmask] with the message: info PED-EM-L 
>> The URL for the PED-EM-L Web Page is: 
>> http://listserv.brown.edu/ped-em-l.html
> 
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L 
> The URL for the PED-EM-L Web Page is: 
> http://listserv.brown.edu/ped-em-l.html 
> 
> 
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                 http://listserv.brown.edu/ped-em-l.html

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html