Assistant Professor Northwestern University The Feinberg School of Medicine Chicago, Illinois, United States
Background: Information handoff of ill children between emergency medical service (EMS) providers and emergency department (ED) staff can be incomplete or inefficient, leading to delays in care and negative outcomes. Currently, no pediatric-specific standard process or handoff tool exists to guide EMS or ED staff during this critical time. Objective: To develop a standardized pediatric EMS transfer of care process in the ED via consensus gathered from a nationwide modified Delphi survey. Design/Methods: Via modified Delphi methodology, a multidisciplinary panel of experts from across the United States developed standardized criteria for EMS transfer of care processes and handoff items in the ED. The modified Delphi content was informed from data obtained via standardized interviews and a literature review. The panel was comprised of experts from the network of members in the Emergency Medical Services for Children (EMSC), the National Pediatric Readiness Project (NPRP), and the Pediatric Prehospital Readiness Project (PPRP). Delphi panelists were asked to rank a transfer-of-care process’s or handoff item's importance level for inclusion on a 5-point scale (5=most important/include) during survey rounds. Consensus was defined as greater than 70% of panelists ranking an item greater than 4. Results: The Delphi process, which required three rounds, is summarized in Figure 1. Through this process, consensus was reached on 11 EMS transfer-of-care processes and 41 handoff items. The consensus criteria were then formatted into a transfer of care process, EMS-STAR, and handoff method, ICAST-PEDS, to facilitate adherence to the newly developed criteria (Figure 2).
Conclusion(s): A nationwide multidisciplinary Delphi process established consensus on various pediatric EMS transfer of care processes and handoff items. The items generated by this modified Delphi were developed into the EMS-STAR transfer of care process, including the ICAST-PEDS handoff method for high-quality pediatric EMS-to-ED transfer of care. Future studies will assess the ease of implementation and effectiveness of the EMS-STAR tool in practice. The adoption of a standardized transfer process will prove critical to developing a prehospital-to-hospital system that is safer and more reliable for the care of ill or injured children.
