“At Some Point, You Have to Cut the Cord”: Physician Perceptions of NICU-to-PICU Transfers

OBJECTIVE: Patients undergoing nonemergent neonatal intensive care unit (NICU) to pediatric ICU (PICU) transfer in the United States have complex medical needs and high relative mortality, but there are no best practices guiding these transfers. This qualitative study was designed to address this gap by characterizing facilitators and barriers to effective NICU-to-PICU transfer among physicians. PATIENTS AND METHODS: Semistructured individual interviews were conducted with pediatric intensivists and neonatologists purposively sampled from previous national surveys on transfer processes. Interviews were recorded, transcribed, and qualitatively analyzed using an iterative process to elicit themes until thematic saturation was reached. RESULTS: A total of 21 interviews were conducted among pediatric intensivists (n = 12) and neonatologists (n = 9). Three major themes emerged integral to effective transfer: ICU mutual trust, multidisciplinary presence, and clinician-family partnership. Subthemes of ICU mutual trust were (1) setting patient goals and caregiver expectations and (2) bridging inter-ICU clinical differences, both of which were tied to regular NICU-PICU touchpoints and early communication with families. Tied to the theme of multidisciplinary presence were (3) identifying continuity, in which care overlap was a facilitator and (4) leveraging collective expertise, in which nursing and allied health professionals' knowledge of long-stay patients are a major asset. Clinician-family partnership was linked to subthemes of (5) prioritizing patient needs and (6) addressing culture shock while not overstating the NICU-PICU differences. CONCLUSIONS: In this qualitative study, pediatric intensivists and neonatologists have collectively identified actionable aspects of nonemergent NICU-to-PICU transfer that, if addressed, may benefit patients, families, and providers.