Unanticipated PICU Transfers Of Patients Admitted From The Pediatric ED


Unanticipated PICU Transfers Of Patients Admitted From The Pediatric ED


Publication Date




This study aims to describe the population of patients admitted from the Emergency Department (ED) who were transferred to the PICU within 24 hours of admission and identify patterns in this patient population. It is part of an ongoing study that aims to identify predictive factors for PICU transfers while accounting for variables like seasonality and staffing.


This study was conducted at a quaternary children’s hospital with 2 EDs - combined volume of 95,000 annual visits with an 11% admission rate. From chart review starting in July 2020, clinical information was gathered for patients admitted to the inpatient wards from the ED who were then transferred to the PICU within 24 hours. The demographic variables and clinical characteristics among this patient cohort were reviewed by a multidisciplinary team. The length of stay in relation to timing of transfer was also studied.


From July 2020 to December 2021 there were 128 events requiring transfer to the PICU, roughly 1.4% of admissions from the ED over that time. Patients under 2 years of age accounted for 26.4% of all admissions from the ER but 50.8% of all rapid transfers to the PICU were children under 2 years. Respiratory etiology accounted for 69.6% (n=89) of transfers, with combined Rhino/Enterovirus and RSV infection being the largest subgroup (n=47, 43.5%). Most transfers occurred within 12 hours of admission from the ED (n=87, 68%). Early transfers were associated with a shorter total hospital stay - median (IQR) length of stay was 3 days (2, 4) for patients transferred within 6 hours, compared with those between 6-12 hours (4.5 days (3, 8)) and 12-24 hours (5 (3, 10)).


The preliminary data is shared from a local collaborative group comprised of ED, PICU, hospitalists, and transport services. 18 months of data suggest that nearly half of all transfers to the PICU occur in children less than 24 months of age and 69.6% of all unanticipated transfers are due to a respiratory etiology. This requires validation at other institutions while the Rapid/Unplanned PICU Transfer Collaborate at Children’s Mercy continues to identify areas for improvement.


Poster not submitted.

Document Type


Unanticipated PICU Transfers Of Patients Admitted From The Pediatric ED