Transfer Out of PICU Algorithm

PICU Attending

• Decides that child is ready to be transferred out of the PICU
• Call accepting physician (for general pediatric service, hospitalist service, or Medically Complex Team, call beeper 435-0042) as the child is leaving the PICU and provide a patient summary to the physician carrying this beeper.
• Document conversation with accepting physician in the patient chart

PICU Charge Nurse

• Requests patient room assignment from the Hospital Nursing Supervisor or Bed coordinator
• Notify PICU resident with actual bed assignment when available
• Review the patient transfer sheet for completeness and countersign the patient transfer sheet before the patient leaves the PICU.
• Notify critical care attending and clerk/aide when child is actually leaving the PICU
• Remove completed transfer sheet from patient’s chart after the child leaves the PICU and place the transfer checklist in Ruth Lebet’s office

PICU Resident:

• Write a Transfer Note in the patient's chart for all children being transferred out of the PICU.
  * If there is a delay leaving the PICU, the Transfer Note must be updated before the child actually leaves the PICU
• Remove any specific PICU orders from Cerner that not longer pertain to the child’s care
• Notify the Surgical or Surgical Subspecialty Resident for the transfer of general surgery, ENT, Plastics, Orthopedics, Urology and Trauma patients.
  *PICU resident will directly contact the resident covering the surgical service, tell them that the child will be leaving the PICU and give them any updates as indicated.
  
  If there is a delay in transfer, notify the subspecialty resident when the child actually leaves the PICU
• Notify the Pediatric Admitting Resident (426-4800) for the transfer of the following children out of the PICU: general pediatrics, private pediatrician, pediatric sub-specialists, hospitalists, neurosurgery , solid organ transplant, trauma patients with isolated head trauma, any surgical service that is requesting a pediatric consult.
  * The PICU resident will have to have the name of the private pediatrician if the child is to be transferred to a private pediatrician.
• Notify the senior resident of the accepting pediatric team and provide more clinical details.
• In addition, notify the North Team Pediatric Resident (beeper 425-9116) if the child is being transferred to the Neurosurgical Service since the North Team Pediatric residents cover all Neurosurgical patients.
• After the PICU Charge Nurse confirms the actual bed location for the child being transferred out of the PICU:
  * Resident fills out the pre-printed order form “Transfer Order” with the information below and gives it to the unit clerk
  Transfer to_____________________Service
  Transfer to Service of Accepting Physician ________________
  Contact accepting team resident when patient arrives on accepting unit
  + Signature/Date/Time
• Re-notify the Admitting Resident (426-4800) or if appropriate the Surgical or Surgical Subspecialty Resident or North Team Pediatric Resident (beeper 425-9116) just before the child leaves the PICU. Confirm that the child is going to the appropriate service. This is necessary since several hours can elapse between the time the initial contact was made and when the child actually leaves the PICU.

Pediatric Admitting Resident

• Assigns pediatric patients coming out of PICU to the appropriate service team.
• Provides the PICU resident with the name of the accepting service and the accepting physician.
• Relays the information about the patient coming out of the PICU to the accepting resident team leader.
• May direct the PICU Resident to also contact the senior resident of the accepting team to give more detailed interactions before patient transfer out of PICU
• Updates the accepting resident team if the PICU resident updates them with new information that has occurred during the time period between deciding to send the child out of the PICU and the actual transfer time.

PICU Unit Clerk will:

• Place a Transfer Checklist on the front cover of the patient’s chart and assist PICU Nurse to make sure checklist is complete
• Enter the resident written “Transfer Order” into Cerner under the appropriate sections.
  Transfer to _________________________________Service
  Transfer to Service of Accepting Physician _________________________________
  Contact accepting team resident when patient arrives on accepting unit.
  
  If the Service or Accepting Physician changes before the child leaves the PICU, the unit Clerk is to make the appropriate changes in Cerner.
• Check Cerner that an Accept Order has been placed for the child being transferred out of the PICU. Notify the critical care attending if an Accept Note is not present. The child cannot leave the PCU until an Accept Order has been placed by the accepting team.

Individual patient’s PICU Nurse

• Discuss child’s clinical course and ongoing needs with the accepting nurse

Individual patients Respiratory Therapist

• Discuss child’s clinical course and ongoing needs with the accepting respiratory therapy team.
• The nurse who receives the patient upon transfer from the PICU
• It is our expectation that the nurse who receives the child from the PICU will contact the accepting team resident immediately when the patient arrives on the accepting unit.

Resident / Intern on the accepting service

• It is our expectation that the Interns and residents on the accepting service will examine the patient, review and adjust orders and immediately discuss the patient’s status and care with the designated accepting attending

PICU Designated Nurse / Physician Follow-Up Team:

• Usually the day after transfer, there is a follow-up visit by designated PICU nursing staff and critical care attending to ask the patient, family, accepting nurses and physicians for feedback on the transfer process from the PICU to the general hospital area.
  
  Comments are entered on the original transfer check off sheet and the transfer sheet is returned to the PICU Nurse Manager

PICU Nurse Manager or designee:

• Store the completed patient transfer check-off sheets.
• Present the completed patient transfer sheets for quality review at the weekly PICU Leadership Meetings.

Transfer Flow Sheet Form