Optimal Complex Patient Transfers: NICU Graduation to PICU-Perspective and Process

Nighttime transfers of patients between different teams in medicine are considered high risk for medical error. Many institutions are implementing process improvement protocols to minimize this error. It is not uncommon for complex pediatric patients to be transferred from the Neonatal Intensive Care Unit (NICU) to the Pediatric Intensive care unit (PICU) during their hospitalization. Patients who transfer, “NICU graduates,” have often had prolonged hospitalization. Typically, these patients are chronically critically ill. Despite the “perceived stability” of these “NICU graduates” transfer of patients from the NICU to the PICU can be fraught with problems and result in patient complications, family dissatisfaction and medical personnel frustration if not performed in a multifaceted, coordinated, multidisciplinary manner. Using a case example, we highlight some of the issues that can occur with these transfers and introduce a transfer process that can help to minimize handover related errors.