{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T12:04:44Z","timestamp":1789905884185,"version":"4.0.1"},"reference-count":15,"publisher":"Walter de Gruyter GmbH","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"Abstract<\/jats:title>\n \n Objectives<\/jats:title>\n Inter-facility transfers to the pediatric intensive care unit (PICU) increase the risk of patient harm from communication breakdowns. We previously developed I-PASS-to-PICU, a structured inter-facility handoff program to improve information exchange during these transitions. However, it was not designed to optimize communication related to diagnosis (diagnostic handoff). This exploratory study evaluated how well I-PASS-to-PICU facilitated inter-facility diagnostic handoffs.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Using mixed methods, we analyzed audio-recorded referral calls to a single PICU to characterize inter-facility diagnostic handoff communication before and after I-PASS-to-PICU implementation. Two pediatric intensivists trained to review calls indicated whether diagnosis-relevant information or activities were discussed. Discrepancies in review were resolved via consensus. Reviewers also provided qualitative observations on diagnosis-related discussions.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Forty-four referral calls were reviewed (16\u00a0pre-and 28 post-I-PASS-to-PICU implementation). Compared with unstructured handoffs, I-PASS-to-PICU use did not result in statistically significant differences in the communication of diagnosis-related information in inter-facility handoffs. However, we observed some absolute differences; there were more calls using I-PASS-to-PICU in which illness severity was discussed (75\u202f% vs. 50\u202f%) and the primary diagnosis was stated by the referring clinician (68\u202f% vs. 44\u202f%) or receiving PICU physician (39\u202f% vs. 25\u202f%). Qualitative analysis revealed that shared mental models were more effectively created when primary diagnoses and diagnostic uncertainty were discussed.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n I-PASS-to-PICU may support aspects of the inter-facility diagnostic handoff but needs further revision to facilitate consistent discussion of diagnoses and diagnostic uncertainty. Future work will focus on redesigning and evaluating I-PASS-to-PICU for improving the diagnostic handoff during inter-facility PICU transfers.<\/jats:p>\n <\/jats:sec>","DOI":"10.1515\/dx-2026-0083","type":"journal-article","created":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T11:55:46Z","timestamp":1789905346000},"source":"Crossref","is-referenced-by-count":0,"title":["Diagnosis-related handoffs for inter-facility transfers to the pediatric intensive care unit"],"prefix":"10.1515","author":[{"given":"Irene","family":"Pantekidis","sequence":"first","affiliation":[{"name":"Division of Medical Critical Care, Department of Pediatrics , Boston Children\u2019s Hospital , Boston , MA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Poornima","family":"Pandiyan","sequence":"additional","affiliation":[{"name":"Division of Medical Critical Care, Department of Pediatrics , Boston Children\u2019s Hospital, Harvard Medical School , Boston , MA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hardeep","family":"Singh","sequence":"additional","affiliation":[{"name":"Safety, Quality and Well-Being Institute at Houston Methodist , Houston , Texas , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher P.","family":"Landrigan","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics, Department of Pediatrics , Boston Children\u2019s Hospital, Harvard Medical School , Boston , MA , USA"},{"name":"Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology , Brigham and Women\u2019s Hospital, Harvard Medical School , Boston , MA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7449-802X","authenticated-orcid":false,"given":"Christina L.","family":"Cifra","sequence":"additional","affiliation":[{"name":"Division of Medical Critical Care, Department of Pediatrics , Boston Children\u2019s Hospital, Harvard Medical School , Boston , MA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"2026092011554073476_j_dx-2026-0083_ref_001","doi-asserted-by":"crossref","unstructured":"Noje, C, Costabile, PM, Henderson, E, O\u2019Donnell, E, Bhatia, P, Singh, S, et al.. Diagnostic discordance in pediatric critical care transport: a single-center experience. Pediatr Emerg Care 2021;37:e1616\u201322. https:\/\/doi.org\/10.1097\/PEC.0000000000002135.","DOI":"10.1097\/PEC.0000000000002135"},{"key":"2026092011554073476_j_dx-2026-0083_ref_002","doi-asserted-by":"crossref","unstructured":"Usher, MG, Fanning, C, Wu, D, Muglia, C, Balonze, K, Kim, D, et al.. Information handoff and outcomes of critically ill patients transferred between hospitals. J\u00a0Crit Care 2016;36:240\u20135. https:\/\/doi.org\/10.1016\/j.jcrc.2016.08.006.","DOI":"10.1016\/j.jcrc.2016.08.006"},{"key":"2026092011554073476_j_dx-2026-0083_ref_003","doi-asserted-by":"crossref","unstructured":"Gausche-Hill, M, Ely, M, Schmuhl, P, Telford, R, Remick, KE, Edgerton, EA, et al.. A national assessment of pediatric readiness of emergency departments. JAMA Pediatr 2015;169:527\u201334. https:\/\/doi.org\/10.1001\/jamapediatrics.2015.138.","DOI":"10.1001\/jamapediatrics.2015.138"},{"key":"2026092011554073476_j_dx-2026-0083_ref_004","doi-asserted-by":"crossref","unstructured":"Thirnbeck, CK, Espinoza, ET, Beaman, EA, Rozen, AL, Dukes, KC, Singh, H, et al.. Interfacility referral communication for PICU transfer. Pediatr Crit Care Med 2024;25:499\u2013511. https:\/\/doi.org\/10.1097\/PCC.0000000000003479.","DOI":"10.1097\/PCC.0000000000003479"},{"key":"2026092011554073476_j_dx-2026-0083_ref_005","unstructured":"Cifra, C, Farag, R, Dukes, K, Gomez, R, Holland, I, Rouse, E, et al.. Ethnography of a diagnostic process handoff: referral communication for pediatric intensive care unit admission and the diagnosis of critically ill children In: Society to improve diagnosis in medicine conference 2023. Cleveland, OH; 2023."},{"key":"2026092011554073476_j_dx-2026-0083_ref_006","unstructured":"Carayon, P, Werner, N, Makkenchery, A, Mossburg, S. 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Electronic health record reviews to measure diagnostic uncertainty in primary care. J\u00a0Eval Clin Pract 2018;24:545\u201351. https:\/\/doi.org\/10.1111\/jep.12912.","DOI":"10.1111\/jep.12912"},{"key":"2026092011554073476_j_dx-2026-0083_ref_012","doi-asserted-by":"crossref","unstructured":"Cifra, CL, Custer, JW, Smith, CM, Smith, KA, Bagdure, DN, Bloxham, J, et al.. Diagnostic uncertainty among critically ill children admitted to the PICU: a multicenter study. Crit Care Med 2025;53:e294\u2013307. https:\/\/doi.org\/10.1097\/CCM.0000000000006511.","DOI":"10.1097\/CCM.0000000000006511"},{"key":"2026092011554073476_j_dx-2026-0083_ref_013","doi-asserted-by":"crossref","unstructured":"Starmer, AJ, Spector, ND, Srivastava, R, Allen, AD, Landrigan, CP, Sectish, TC, et al.. I-PASS, a mnemonic to standardize verbal handoffs. Pediatrics 2012;129:201\u20134. https:\/\/doi.org\/10.1542\/peds.2011-2966.","DOI":"10.1542\/peds.2011-2966"},{"key":"2026092011554073476_j_dx-2026-0083_ref_014","doi-asserted-by":"crossref","unstructured":"Patel, SJ, Ipsaro, A, Brady, PW. Conversations on diagnostic uncertainty and its management among pediatric acute care physicians. Hosp Pediatr 2022:e2021006076. https:\/\/doi.org\/10.1542\/hpeds.2021-006076.","DOI":"10.1542\/hpeds.2021-006076"},{"key":"2026092011554073476_j_dx-2026-0083_ref_015","doi-asserted-by":"crossref","unstructured":"Rosenthal, JL, Li, STT, Hernandez, L, Alvarez, M, Rehm, RS, Okumura, MJ, et al.. Familial caregiver and physician perceptions of the family-physician interactions during interfacility transfers. Hosp Pediatr 2017;7:344\u201351. https:\/\/doi.org\/10.1542\/hpeds.2017-0017.","DOI":"10.1542\/hpeds.2017-0017"}],"container-title":["Diagnosis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/dx-2026-0083\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/dx-2026-0083\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T11:55:50Z","timestamp":1789905350000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyterbrill.com\/document\/doi\/10.1515\/dx-2026-0083\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,21]]},"references-count":15,"alternative-id":["10.1515\/dx-2026-0083"],"URL":"https:\/\/doi.org\/10.1515\/dx-2026-0083","relation":{},"ISSN":["2194-8011","2194-802X"],"issn-type":[{"value":"2194-8011","type":"print"},{"value":"2194-802X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,21]]}}}