(807) Neonatologist Perspectives on Non-Emergent NICU-to-PICU Transfers

Introduction: There is increasing attention on the subpopulation of pediatric ICU (PICU) patients who transfer directly from the neonatal ICU (NICU). A recent national survey study of PICUs in the United States demonstrated that the majority of representative pediatric intensivists believe standardization of this process is important and beneficial to patient care. However, corresponding neonatologist perspectives have not been characterized.

Methods: We administered a web-based survey of neonatologists throughout the United States at the same hospitals as the previous PICU survey, querying their institutional practices for NICU to PICU intrafacility transfer as well as their perspectives on those practices. We compared these responses with those of PICU physicians nationally.

Results: At this interim analysis, we have received responses from 31 of 78 institutions, for an overall 40% response rate (study ongoing). The sample of institutions largely consists of academic centers with medium to large PICUs (median 28 beds, IQR 21-40) and NICUs (median 65 beds, IQR 51-91), with most featuring fellowship programs in NICU (86%) and PICU (80%) training. At interim, consistent with the previous cohort of PICU physicians, the neonatologists surveyed reported a median of 5 annual non-emergent NICU to PICU transfers (IQR 2-8) with infrequent protocolization (31%) of this transfer process beyond frontline clinician and bedside nursing handoff. Similar to that previous survey, neonatologists nevertheless saw protocolization as important for patient safety (90%) and the patient-family experience (94%). Neonatologists (39%) judged their current transfer practices as more ineffective for providers than their PICU colleagues (19%; p< 0.01).

Conclusions: Neonatologists corroborated the survey data of PICU physicians regarding the frequency of non-emergent intrafacility NICU to PICU transfer and existing practices to execute those transfers. Their support of standardizing these transfers for patient safety and the patient-family experience adds to existing evidence showing PICU physicians welcome this practice. Neonatologists' evaluations of existing transfer practices were less positive than those of their counterparts in the PICU, suggesting multidisciplinary efforts to optimize these transfers would be welcome in the NICU.