WIP 4 - The Safety Implications of Nighttime PICU to Floor Transfers

Poster Number: WIP 4
Publication Number: WIP 4.987

Background: Nighttime transfers from the adult intensive care unit (ICU) to the floor are common and associated with an increased risk of in-hospital mortality and unplanned returns to the ICU.​ In pediatric patients, unplanned returns to the pediatric intensive care unit (PICU) during the same hospitalization are associated with higher mortality, though the association between nighttime transfer out of the PICU and unplanned return to the PICU remains uncertain.​

Objective: The primary aim of this study is to determine if nighttime transfers from the PICU to the floor are associated with unexpected clinical deterioration on the floor, resulting in a rapid-response team (RRT) activation, code blue event, or return to the PICU within 48 hours. The secondary aim is to identify patient characteristics that are associated with these negative patient safety outcomes.

Design/Methods: Institutional IRB approval was obtained for this study. This is a retrospective cohort study design at a single, large academic children’s hospital. The study population is children and young adults ages 0 to 23 years who were transferred out of the PICU to the floor between January 1, 2022 through December 31, 2022. The exposure of interest is nighttime transfer out of the PICU (defined as 21:00 – 08:59). The primary outcome is occurrence of clinical deterioration (defined as either an RRT activation, code blue event, or unplanned return to the PICU within 48 hours of initial transfer out of the PICU). We collected patient demographic and clinical information, including admitting and chronic diagnoses, critical care services received in the PICU, and medical complexity to control for confounding variables. The statistical plan includes descriptive statistics to characterize the study population and logistic regression to determine the association between the primary outcome and the candidate predictor variables of nighttime transfer and other patient characteristics.