Implementation Study of Intra-hospital Transfer of Pediatric Inpatients

Not Applicable

Completed

• Conditions: Implementation Science; Transportation of Patients
• Interventions: Behavioral: Routine transport; Behavioral: Post-guideline transfer

• Registration Number: NCT06512805
• Lead Sponsor: Children's Hospital of Fudan University

Brief Summary

This study implemented the "Clinical Practice Guidelines for In-hospital Transfer of Pediatric Inpatients (2023 edition)" released by the research team in June 2023 in real clinical settings. It employed an effectiveness-implementation hybrid research design to evaluate the process and effects of the guidelines in clinical practice. The research objectives include the following aspects:

Identifying barriers to the implementation of the guidelines in clinical practice.

Constructing implementation strategies to facilitate the application of the guidelines based on identified barriers.

Evaluating the impact of implementation strategies on clinical healthcare personnel and the clinical environment.

Assessing the effect of in-hospital transfer of pediatric inpatients based on the guidelines on reducing adverse events related to in-hospital transfers and other clinical outcomes.

Participants will:

In the control group, healthcare personnel conduct transfers according to the routine management and working mode of the emergency department and pediatric intensive care unit (PICU).

In the intervention group, nurses receive implementation strategies developed during the preparation phase. These strategies are aimed at modifying the behavior of healthcare personnel through implementation, thereby conducting in-hospital transfers for pediatric patients based on the guidelines.

Detailed Description

The demand for in-hospital transfers is high, and their occurrence rate is frequent, making them an unavoidable routine in hospital settings due to emergency patients, postoperative patients, and those highly dependent on specialized medical equipment. Research statistics indicate that out of 371 patients admitted to the neonatal ward, there were 1402 transfers, while 506 emergency department patients accounted for 2715 in-hospital transfers. Additionally, 43.5% of patients in the intensive care unit required repeated transfers, with 45% of them needing two or more transfers. According to a systematic review by Haydar et al., adverse event rates during in-hospital pediatric transfers ranged from 0.11% to 75%, with the most common events being hypoxemia (13%-21%), hypotension (3.3%-37.5%), chest compressions (7.5%), dislodgement/accidental removal of catheters (3.8%), and interruption of vasopressor infusions (5%). Therefore, ensuring the safety of in-hospital transfers for pediatric patients is a crucial aspect of healthcare workers' responsibilities. Standardizing the in-hospital transfer process to minimize adverse events is vital for the well-being of pediatric patients.

Thus, this study focuses on in-hospital transfers of pediatric patients, aiming to identify current clinical issues and implement strategies based on the "Clinical Practice Guidelines for In-hospital Transfer of Pediatric Inpatients (2023 edition)." Conducted at the Children's Hospital affiliated with Fudan University, the research aims to develop implementation strategies and evaluate the impact of evidence and implementation strategies on pediatric inpatients, the evidence-based practice behavior of clinical healthcare personnel, and changes in the hospital organizational environment. The goal is to alter current clinical practices, standardize the in-hospital transfer process for pediatric patients, and further reduce adverse events associated with in-hospital transfers.

Study Timeline

• Study Start: 2024-04-01
• Study First Submitted: 2024-06-27
• Study First Submitted QC: 2024-07-19
• Study First Posted: 2024-07-22
• Primary Completion: 2024-12-31
• Study Completion: 2024-12-31
• Status Verified: 2025-01
• Last Update Submitted: 2025-01-16
• Last Update Posted: 2025-01-17

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 214

Inclusion Criteria

• Those who had worked in the study site for more than 1 year;

  • Those who can carry out intra-hospital transport independently;

    • Staff on duty during the study period

Exclusion Criteria

• Those who have not obtained a practicing qualification certificate;

  • Refusal to participate in the study；

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SEQUENTIAL

Arm && Interventions

Group	Intervention	Description
Routine transport group	Routine transport	During the period from April 2024 to June 2024, pediatric patients transferred from the emergency department to the pediatric intensive care unit (PICU), and from the PICU to general wards will serve as the control group. They will undergo the hospital's current in-hospital transfer process.
Post-guideline transfer group	Post-guideline transfer	During the period from September 2024 to November 2024, pediatric patients transferred from the emergency department to the pediatric intensive care unit (PICU), and from the PICU to general wards will undergo the in-hospital transfer process based on the "Clinical Practice Guidelines for In-hospital Transfer of Pediatric Inpatients (2023 edition)."

Primary Outcome Measures

Name	Time	Method
The compliance of healthcare personnel with evidence-based practice.	Three months before and three months after the intervention	The compliance of each review indicator = (Number of times the indicator was correctly executed / Total number of times the indicator was reviewed) \* 100%.
Rate of adverse events during in-hospital transfers	Three months before and three months after the intervention	Adverse event rate = Number of patients experiencing adverse events during transfer / Total number of patients transferred during the study period
Intra-hospital transfer time	Three months before and three months after the intervention	The in-hospital transfer time = Time when the transfer team leaves the receiving department - Time when the transfer team leaves the transferring department.
Bedside handover time	Three months before and three months after the intervention	Departure time of the transfer team from the receiving department - Start time of the handover.
Completeness of information handover	Three months before and three months after the intervention	The ratio of completed items in the handover checklist to the total items in the handover checklist
Healthcare personnel's knowledge level of in-hospital transfers	One month before and one month after the intervention	"In-hospital Transfer Knowledge Level Questionnaire for Healthcare Personnel"

Trial Locations

Locations (1)

Children's Hospital of Fudan University; 🇨🇳 Shanghai, China