(1335) Implementing and Improving Utilization of an Intra-Hospital Transport Checklist in the PICU

Introduction: Intra-hospital transport is a common occurrence in the Pediatric Intensive Care Unit (PICU), where critically ill patients require diagnostic tests or procedural interventions to treat their conditions. Our facility had no formal guidelines in place for a prescriber's presence in these high-risk transports. In the wake of two unplanned extubations and a cardiac arrest during transport, a multi-disciplinary committee underwent the task of developing patient criteria for prescriber travel and a bedside checklist for all off-unit transports.

Methods: A multi-disciplinary group of critical care prescribers, nurses, and respiratory therapists developed agreed-upon patient criteria for provider travel and necessary equipment. The checklist was implemented in December 2022. We developed the SMART goal of utilizing the checklist for 80% of all transports by the end of the 2023 calendar year. Our quality improvement staff, who attend bedside rounds, reminded the teams of their use. For data, we collected number of transports and checklist utilization to benchmark our progress. We also collected transport location, vasopressor requirement, nighttime or daytime travel, and if the patients were mechanically ventilated or on increased oxygen support.

Results: There were 428 transports during 2023 noted in chart review. 31% of the transports were at night. 69% of patients were on increased oxygen support, 55% of the transports were intubated, 8% were on pressors, and CT was the most common destination, at 52% of total transports. In January 2023, utilization rate was 27%. In November and December 2023, utilization rate had improved to 70%, short of our SMART goal but with improvement in utility. There were two unplanned extubations during transports, and prescribers were present during one event.

Conclusions: Intra-hospital transports with PICU patients are high risk ventures requiring significant resource utilization. We created formal prescriber travel criteria and equipment/patient care checklists for transports in our PICU with improved utilization with success, but fell short of our SMART goal and ultimate goal of standardizing every transport preparation.