Child on gurney

Parents of a sick child in the Emergency Department (ED) feel a sense of relief when the healthcare team steps in, but it can also be a critical moment in terms of safety. The complexity of patient handovers – when a patient is transferred from one care setting to another – can be particularly challenging when the transfer involves a child being moved from the ED to an inpatient unit for further care and treatment.  

Across Fraser Health, approximately 16% of ED visits are children with 3.4% of those (nearly 3,500 children per year) being admitted. To enhance the effectiveness of communication during transfers and reduce the occurrence of safety events, a team of Fraser Health nurses from both Pediatric and Emergency Departments worked together to launch a quality improvement project at two Fraser Health hospitals in 2015.

Mary Spencer, Clinical Nurse Specialist (CNS) and project lead, says a formalized approach is the best and safest way to ensure optimal continuity of care for children who are moved from the ED to a pediatric inpatient unit.

“We have 12 EDs within Fraser Health that manage both adult and pediatric care. Communication at transitions of care was seen as an opportunity for improvement because the old forms were adult-focused and outdated. We also reviewed our BC PSLS data to look for ways to improve.”


Pediatric Shared Transfer of Care_Page_1

Fraser Health’s Pediatric Shared Transfer of Care form (page 1)

Four months into the pilot, the team evaluated the new two-part patient handover process (written and verbal), which showed positive results in several areas:

  • 83% of nurses in the ED and inpatient units found the new form user-friendly.
  • 75% of inpatient nurses felt the form increased their ability to be better prepared for new patients.
  • 62% of ED nurses felt the process provided a more complete handover report.
  • Time-to-transfer from the ED to inpatient units improved by 5.8% (up to 8 minutes less time in ED per child)
  • Patient safety events related to transfers decreased.

In addition, anecdotal feedback was useful for identifying lessons learned that supported rollout to other Fraser Health hospitals:

  • A combination of written and verbal communication during handover promotes collaboration between ED nurses and pediatric inpatient nurses so all services are working together to ensure patient safety.
  • The ED is an area with high acuity and patient turnover. Experienced ED nurses have an opportunity to mentor novice ED nurses to support effective transitions and smooth management of a patient’s care.

    Pediatric Shared Transfer of Care_Page_2

    Fraser Health’s Pediatric Shared Transfer of Care form (page 2)

Next steps

The new Pediatric Shared Transfer of Care process started at two Fraser Health hospitals. In April 2016, the team enlisted the other 10 hospitals in Fraser Health and is now evaluating all 12 hospitals to see whether these positive results continue. Safety events will be closely evaluated, and the team is continuing to look for ways to improve patient safety and care transfers.

BC PSLS Central Office will catch-up with Mary and the team in a few months.

If you would like to learn more about their project, please contact Mary Spencer at, Charlene Cena at or Mary Van Osch at



BC PSLS Central Office would like to acknowledge Mary Spencer, Charlene Cena, Mary Van Osch, Joanne Shum, Loraine Jenkins, the Fraser Health Maternal Infant Child & Youth Program, and the Emergency Shared work team for their leadership in improving patient safety.

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