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Reducing unnecessary delays during the transfer of patients from the paediatric intensive care unit to the general ward: a quality improvement project
  1. Hamza Alali1,2,
  2. Yasser Kazzaz1,2,3,
  3. Ali Alshehri1,2,3,
  4. Mohannad Antar1,
  5. Ousaima Alhamouieh4,
  6. Zahra Hasan5,
  7. Khaled Al-Surimi6,7
  1. 1Department of Pediatrics, Ministry of the National Gaurd-Health Affairs, Riyadh, Saudi Arabia
  2. 2King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
  3. 3College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
  4. 4Quality and Patient Safety Department, Ministry of the National Gaurd-Health Affairs, Riyadh, Saudi Arabia
  5. 5Nursing Services, Ministry of the National Gaurd-Health Affairs, Riyadh, Saudi Arabia
  6. 6Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
  7. 7Primary Care and Public Health, Imperial college London, London, United Kingdom
  1. Correspondence to Dr Hamza Alali; drhamza80{at}


Introduction Delaying the discharge of paediatric intensive care unit (PICU) patients is directly proportional to increased occupancy rate and cost. We aimed to study the process of transferring patients from the PICU to the general ward in order to improve the timeliness of this process while guaranteeing patient safety.

Methods A multidisciplinary quality improvement (QI) team was formed to analyse the transfer process. Several Plan Do Study Act cycles were tested, targeting all steps of the transfer process, and applying turnaround time (TAT)—the duration from the time of clinical transfer decision until the physical transfer of the patient—as an outcome measure, aiming for a TAT of 4 hours.

Results Baseline results showed that medical transfer decisions by PICU attending physicians were taken late for most patients: only 19% of decisions were made by 08:00 by the on-call team. Average TAT of the transfer process was over 7 hours, with duration ranging from 7 to 17 hours. After implementing all suggested improvement interventions, early decision compliance improved to 59%. TAT improved gradually, starting in January 2017, until it approached our target (284–261 min≈4 hours) in February–May 2017.

Conclusion PICU patient transfer process delays can be reduced by early evaluation, timely team communication and proper preparation. It is recommended that all personnel with early involvement avoid unnecessary delays by paying more attention to all process steps, starting with the clinical decision, until the physical transfer. Standardising transfer processes might lead to a decrease in the length of PICU stay, which is a desirable outcome, but this observation needs further exploration.

  • critical care
  • quality improvement
  • paediatrics
  • patient discharge

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  • Contributors HA: Quality improvement project team leader, project conduction, manuscript writing.YK: Quality improvement project team co-leader, data analysis, interventions planning and conducting, manuscript review. AA: PICU head division, improvement interventions conduction, manuscript review. MA: Quality improvement project team member, follow project progress, data collection, introduction and discussion writing. OA, QI specialist: Quality improvement project team member, data analysis, methodology writing. ZH: Quality improvement project team member, nursing related interventions conduction, data collection. KA-S: Project mentor, methodology writing, manuscript edit. HA (team leader) is responsible for the overall content in this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This project was approved by the hospital’s quality improvement and patient safety department and the Instititutional Review Board (IRB).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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