574 - Pediatric Transfer Telephone Calls: Referring Emergency Clinician Perspectives on Current State and Proposed Sepsis Interventions

Publication Number: 1551.574

Caroline I. Tietbohl, University of Colorado Anschutz, Aurora, CO, United States; Bentley Porterfield-Finn, University of Colorado School of Medicine, Denver, CO, United States; Ashley C. Dafoe, University of Colorado School of Medicine, Thornton, CO, United States; Jenna T. Jordan, University of Colorado School of Medicine, Aurora, CO, United States; Halden F. Scott, University of Colorado School of Medicine, Denver, CO, United States

Background: A conversation with an accepting physician is legally mandated before transfer of a patient out of an Emergency Department (ED) in the United States. General emergency physicians have described that receiving live advice during this call is an important resource in their emergency care for children, particularly for sepsis. Sepsis is a high-risk condition frequently requiring transfer, in which early diagnosis is potentially lifesaving, and often challenging. Despite the ubiquity and importance to emergency physicians of real-time telephone consultation with pediatric specialists, there has been little study of the optimal content and structure of these calls.

Objective: The goal was to understand general ED clinicians' experiences with transfer phone calls to children's hospitals, with a focus on sepsis. We sought to inform development of transfer call interventions to support diagnosis of sepsis.

Design/Methods: Semi-structured interviews were conducted via video conference with referring general ED providers (physicians, nurse practitioners, physician assistants). Clinicians who transferred a patient with sepsis in the last 5 years were recruited via email. Maximum variation purposeful sampling was used to recruit from a range of settings. Data collection continued until thematic saturation was reached. Interviews were conducted by a professional qualitative researcher and recorded. Interviews were deidentified, professionally transcribed verbatim, and analyzed using rapid qualitative analysis.

Results: 15 interviews were completed with clinicians from 12 EDs across four states (CO, KS, WY, NM). Interviews revealed 5 themes: 1) importance of communication, 2) role of location in diagnosis and transfer decisions, 3) lack of pediatric sepsis resources and experience, 4) acceptability of vital sign reporting during calls, and 5) acceptability of a sepsis diagnostic checklist. Many participants reported having little experience with pediatric sepsis and valued receiving advice on transfer calls. Limitations around ED location and available resources impacted the timing of transfer calls, their goals and approach to communication. Participants also described effective communication strategies that accepting physicians used, including being asked for vitals.

Conclusion(s): The transfer call is a high-risk, influential moment for communication and diagnostic safety. Participants identified communication approaches that improved their transfer call experience, and supported interventions around vital signs during transfer calls, and sepsis diagnostic checklists.

Table 1.
Referring provider participant characteristics

Table 2.
Themes and supportive quotations about transfer calls

Table 3.
Themes and supportive quotations about sepsis transfers and interventions