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Inter‐shift variation in unscheduled intensive care unit transfers at a children's hospital
Author(s) -
Inata Yu,
Aoki Yoshihiro,
Hatachi Takeshi,
Shimizu Yoshiyuki,
Takeuchi Muneyuki
Publication year - 2018
Publication title -
pediatrics international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 63
eISSN - 1442-200X
pISSN - 1328-8067
DOI - 10.1111/ped.13536
Subject(s) - medicine , evening , emergency medicine , intensive care unit , adverse effect , resuscitation , cardiopulmonary resuscitation , pediatrics , medical emergency , intensive care medicine , physics , astronomy
Background The early detection of clinical deterioration and the prompt escalation of care is important but may be limited in the general ward, especially at night. Identifying variations between work shifts in the number of unscheduled in‐hospital intensive care unit ( ICU ) transfers and emergency transfers involving life‐threatening conditions may help implement targeted interventions to reduce delayed transfers and improve patient safety and outcomes. Methods All unscheduled ICU transfers in a tertiary children's hospital, from January 2013 to December 2016, were reviewed retrospectively. The transfers were categorized into safe transfers and adverse safety events ( ASE ). The 4 year cumulative numbers for each transfer category in each work shift (day, evening, and night) were assessed for comparison. An ASE was defined as transfer after cardiopulmonary resuscitation or tracheal intubation in the ward, or an unrecognized situation awareness failure event transfer, which was defined as previously reported. Results Of 244 unscheduled in‐hospital ICU transfers, 167 were safe transfers and 77 were ASE . The number of unscheduled transfers and of ASE was highest during the day shift ( n = 133 and 40, respectively) and lowest during the night shift ( n = 25 and 12, respectively). In contrast, the proportion of ASE in the unscheduled transfers was higher during the night shift (48%) compared with the day and evening shifts (30% and 31%, respectively). Conclusions The occurrence of unscheduled ICU transfers was disproportionately low during the night shift, whereas the majority of ASE happened during the day shift. Future studies focusing on unravelling the reasons for such variations are warranted.