Evaluation of a paediatric inter-facility transfer initiative for acutely unwell children in regional Queensland: Standardised Workflow for Inter-Facility Transfer of Kids [SWIFTKids]

The SWIFTKids workflow algorithm was implemented across the Sunshine Coast Hospital and Health service (SCHHS) in early 2019 with the education package rolled out in May 2019 and Sunshine Coast HHS Paediatric Inter-Facility Transfer Procedure (workflow algorithm) was rolled out in July 2019. The strategy is now a part of routine care for all paediatric patients being transferred across the Hospital and Health Service. The risk of deterioration was identified as a clinical risk concern and need for improvement for patient safety. Implementation of the SWIFTKids Strategy SWIFTKids was developed based on the local identification of factors influencing sub-optimal outcomes and existing literature. SWIFTKids involves: *Development and implementation of a standardised workflow algorithm for paediatric inter-facility transfers; including a risk stratification approach to triage transfer requirements [traffic lights], and fit-for purpose documentation. *Introduction of standardised tele/video-conferencing for consultation between senior medical staff of the referral and accepting facilities. *Development of an interdisciplinary education package for staff involved in the referral and transfer of paediatric patients. The workflow algorithm is a Sunshine Coast Hospital and Health Service (SCHHS) instruction on how to properly execute a transfer of a paediatric patient from outlying hospitals to Sunshine Coast University Hospital (SCUH) or to Queensland Children's Hospital that was implemented in October 2018. The purpose is to ensure patients "receive care in the most appropriate setting and that their right to safety and access in health care is best supported" and "that access is coordinated, clinically prioritised, safe and patient-centric" (Sunshine Coast University Hospital and Health Service, 2021). It includes a traffic light triage tool to assist providers in choosing the most appropriate mode of transfer (i.e. Retrieval Services Queensland, Queensland Ambulance Service [with or without a nurse escort] or via privately owned vehicle). The workflow algorithm also stipulates the manner of communication between sending and receiving hospital teams and the documentation that is required for each transfer. The workflow algorithm is available on the Sunshine Coast University Hospital and Health Service's area of the intranet site Queensland Health Electronic Publishing Service. It has a checklist that is to be completed by staff prior to the patient's departure for transfer. The workflow algorithm contains hyperlinks to the required forms for staff to complete in preparation for and during transfer. The workflow algorithm is intended for use by medical and nursing staff involved in paediatric inter-hospital transfers (PIHT) and should be utilised for each transfer from outlying emergency departments. Adherence to the workflow algorithm will be assessed in Phase 1, Objective 2 of the SWIFTKids study. Two investigators will perform reviews on 30 patient charts to assess adherence to structure measures and process measures. Structure measures to be assessed include: *Compliance with PIHT forms by nurse escorts *Use of phone/video consult forms by paediatrician/receiving medical officer *Documentation of the 3 or 4 way-conversation in the integrated electronic Medical Record (ieMR) Process measures to be assessed include: *Phone consultation pathway (acceptability of tele- and/or video-health process; number of calls required to arrange transfer; possible barriers due to complication with the technology) *Accuracy of applying the risk-stratification process in categorising children's care prior to transfer (clinical deterioration en-route, need for nurse escort, alteration to intended arrival location) *Record of algorithm violations and missing data eg patient transferred without utilisation of 3 or 4-way conversation *Accuracy of risk stratification in identifying level of escort required as defined in the workflow algorithm *Unexpected deterioration en route and/or escalation to the paediatric critical care unit on arrival to SCUH Phase One: Structure and Process Study The structures and processes involved in the SWIFTKids strategy will be evaluated using a multi-methods design. The study will be set within the Sunshine Coast Hospital and Health Service [SCHHS]. Aim: Determine the acceptability and feasibility of SWIFTKids by staff and patients and or family Part 1: Patient and staff experiences will be explored using a qualitative descriptive study. This will involve semi-structured interviews with parents and children, of their perceptions and experiences relating to inter-facility transfer. Data will be thematically analysed. Part 2: The usability and compliance with the implemented structure and process of the SWIFTKids strategy will be examined using a descriptive quantitative study through in-depth electronic medical record chart review by two experienced clinicians. Phase Two: Outcomes Study The aim of this study phase is to evaluate patient health outcomes and health service cost delivery associated with the SWIFTKids strategy. The outcomes of the SWIFTKids strategy will be determined using a pre-post design that tracks eligible patients before and after the strategy implementation (October 2018). Data for all patients aged 0-16 years who have been transferred to SCUH from a referring Sunshine Coast health facility from 1 September 2017- 30 August 2018 AND 1 September 2019 – 30 August 2020 Sunshine Coast University Hospital and Health Service. (2021). Paediatric inter-hospital transfers.