Non-Emergent Neonatal ICU-to-PICU Transfers in the United States: Cross-Sectional Survey of Neonatologists and Pediatric Intensivists

Objective: Our 2023 survey of 81 PICUs in the United States involved in the Prevalence of Acute Rehabilitation for Kids in the PICU (PARK-PICU) network showed that most pediatric intensivists believed standardization of the neonatal ICU (NICU)-to-PICU transfer process was beneficial. We now report a 2024 survey of neonatologists at the same hospitals to query institutional practices for NICU-to-PICU intrafacility transfer and to compare perspectives about practices. Design: Cross-sectional survey study carried out in 2024. Setting: Internet-based. Patients: None. Interventions: None. Measurements and Main Results: Our respondents were from 49 of 75 institutions (65% response rate). The majority were from academic centers (44/49) of medium-to-large size NICUs (median 65 beds interquartile range, IQR, 48–90) and PICUs (median 25 beds IQR, 20–38), with most offering fellowship programs in neonatology (43/49) and pediatric intensive care (38/49) training. Like the report of responding pediatric intensivists, neonatologists reported a median of 5 (IQR 2–8) annual non-emergent NICU-to-PICU transfers, with infrequent protocolization (17/49) of this transfer process beyond frontline clinician and bedside nursing handoff. A minority of neonatologists considered their NICU-to-PICU transfer practices were effective for clinicians (19/48) or families (21/48). Neonatologists similarly saw transfer protocolization as important for patient safety (45/48) and the patient-family experience (45/48). On comparing respondents from institutions with set transfer protocols vs. those from institutions without set protocols, there was greater odds of a transfer being evaluated as effective (odds ratio 3.49 95% CI, 1.01–12.05). Conclusions: In 2024, neonatologists corroborated our 2023 PARK-PICU data about non-emergent intrafacility NICU-to-PICU transfer. These PICU-NICU data dyads now show that neonatologists strongly support standardizing these transfers, and that neonatologists from units with standardized transfer evaluate their processes as having more than three-fold greater odds of perceived transfer effectiveness. Thus, there is multidisciplinary support for standardizing NICU-to-PICU transfer practices.