Early, Unanticipated PICU Transfers: Is There a Need for Improvement?

Triage of patients to the PICU or general ward has important quality and cost implications. Mistriaging a patient to the general ward may cause delays in needed care, with the potential for increased morbidity and mortality.1,2 However, mistriage of patients who do not require critical care interventions to a PICU also has consequences, including increased health care costs for the family; use of limited PICU beds, nurses, and physicians; and heightened familial stress.3–5 Additionally, there may be different expectations for testing and treatment in the ICU environment compared with the acute care ward, even for similar cases, resulting in unneeded tests and treatments.6,7 In this month’s issue of Hospital Pediatrics , Nadeau et al8 describe characteristics and outcomes of a cohort of pediatric patients triaged to the general ward who were subsequently transferred to the PICU within 24 hours of admission (early PICU transfers) between 2007 and 2016. The authors found that 841 of 82 397 (1%) general ward admissions required early PICU transfers. The median time to PICU transfer was 9.1 hours, with an interquartile range of 5.1 to 14.9 hours, meaning that only a small proportion of transfers occurred within the first few hours after admission. A majority of transfers (65%) were due to respiratory deterioration. Of the 841 subjects transferred, …