TOP 32 - I-DISPATCH: Standardizing Communication to Drive Quality Improvement in Pediatric ED-to-PICU Transfers

Publication Number: 4735.TOP 32

Priyanka Nair, Washington University in St. Louis School of Medicine, Ballwin, MO, United States; Nikoleta S. Kolovos, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Yasasvi Vasili, Washington University in St. Louis School of Medicine, St louis, MO, United States; Adem Cemerlic, Washington University in St. Louis School of Medicine, St. Louis, MO, United States; Nurit Haberman, Washington University in St. Louis School of Medicine, St Louis, MO, United States; Jyoti Arora, Washington University in St. Louis School of Medicine, Saint Charles, MO, United States; Tara Copper, Washington University School of Medicine, Saint Louis, MO, United States; Kathryn Leonard, Washington University in St. Louis School of Medicine, Saint Louis, MO, United States; Fahd A. Ahmad, Washington University in St. Louis, St. Louis, MO, United States

Background: Transitions of care are a significant source of medical errors, with communication failures responsible for over 60% of sentinel events. While structured handoff tools such as I-PASS and SBAR can reduce medical errors in pediatric inpatient settings, their structures are not well-suited for Pediatric Emergency Departments (PEDs). An internal needs assessment with local stakeholders identified a need for improved PED to inpatient and Pediatric Intensive Care Unit (PICU) handoffs. We sought to develop a novel, concise, context-specific handoff tool with improved brevity, clarity, and reliability to support PED to PICU handoffs.

Objective: Develop, implement, and evaluate the I-DISPATCH handoff tool (Fig.1) and evaluate effect of implementation on the quality and provider satisfaction of ED-to-inpatient handoffs.

Design/Methods: We conducted mixed-methods Quality Improvement initiative at a free-standing, quaternary care children's hospital; it was classified as exempt by our Institutional Review Board. A multidisciplinary group (physicians, nurses, safety leaders) convened to develop and iteratively refine the I-DISPATCH handoff framework, which was introduced hospital-wide via standardized education. Baseline handoff quality was assessed using retrospective audio recordings of 200 PED-to-PICU handoffs obtained via an established institutional recording system, and provider satisfaction was measured through pre-implementation surveys (N = 154). Two physicians blinded to patient records scored recordings using a composite handoff-quality instrument (Table 1).

Preliminary survey findings showed 68% of respondents rated the existing handoff as fair to good. But, a significant gap in the experiences of the handoff receivers versus handoff providers was noticed (Table 2). This confirmed the need for a unified mnemonic (I-DISPATCH). Post-intervention audio recordings and satisfaction surveys are being analyzed. Results are expected by January 31, 2026. Changes in handoff quality will be compared using paired t-tests, and satisfaction via Wilcoxon signed-rank tests. We anticipate improved composite handoff scores and satisfaction post-implementation, demonstrating that I-DISPATCH can standardize communication & strengthen patient-safety culture in high-acuity PED-to-PICU transfers.

Figure 1. I-DISPATCH Handoff Tool
I-DISPATCH- Handoff tool components and description

Table 1. Transcription scoring tool
Transcription scoring tool used to score audio handoff recordings

Table 2. Preliminary survey results
Pre-intervention provider satisfaction survey analysis results (preliminary)