Pediatric Transport Guidelines Improve Knowledge and Protocol Adherence in Hospital Study

A structured, multi-strategy implementation program guided by implementation science frameworks significantly improved healthcare provider knowledge and adherence to clinical protocols during intrahospital transport of critically ill children, according to a study conducted at Shenzhen Children’s Hospital. The research evaluated the real-world introduction of evidence-based recommendations for pediatric patients transferred from the emergency department to the pediatric intensive care unit, documenting marked progress across clinical audit indicators and provider competency assessments.

Intrahospital transport of critically ill pediatric patients is recognized as a high-risk clinical process that demands rigorous operational safeguards, including standardized risk assessment, structured clinical handover, thorough equipment preparation, and close team coordination. While clinical practice guidelines containing evidence-based recommendations have been developed to mitigate transport hazards, healthcare systems face persistent challenges in translating these published recommendations into routine clinical practice at the bedside.

To overcome these implementation barriers, investigators carried out a single-center, quasi-experimental before-and-after study designed to implement selected recommendations from the 2023 Clinical Practice Guidelines for Intrahospital Transport of Hospitalized Children at a tertiary pediatric center. The implementation process and clinical outcomes were evaluated across two established implementation science frameworks: the Integrated Promoting Action on Research Implementation in Health Services, or i-PARIHS, framework and the RE-AIM evaluation framework.

Prior to introducing the practice changes, the research team utilized the i-PARIHS framework to systematically identify local barriers and facilitators within the tertiary hospital environment. Contextual data were gathered through semi-structured interviews, questionnaire surveys, and direct field observations across the participating clinical units. Drawing upon these assessments, the investigators designed targeted implementation strategies tailored to local operational realities, and all planned implementation strategies were fully executed over the course of the project.

The intervention achieved high uptake among clinical personnel involved in patient transfers between the emergency department and the intensive care unit. Of the 64 eligible healthcare providers identified within the clinical departments, 62 clinicians—representing an overall participation rate of 96.5 percent—took part in the implementation program. Testing revealed a statistically significant improvement in provider knowledge scores following the intervention, with average scores rising from a pre-implementation baseline of 60.36 ± 11.42 to 79.53 ± 11.25 at post-implementation testing (p < 0.001).

Clinical adherence to transport guidelines was tracked across 15 specific audit indicators, demonstrating significant improvements in 9 of those 15 measures. Notably, five newly introduced audit criteria that had shown zero percent adherence during baseline monitoring rose to 100 percent adherence following the intervention. In addition, the remaining four criteria reflected existing clinical practices that were further strengthened through the implementation program, also reaching full 100 percent adherence during post-implementation monitoring.

To evaluate broader clinical impact, the study team prospectively observed transport events, comparing 76 baseline transfers to 78 follow-up transfers organized across the RE-AIM dimensions of reach, effectiveness, adoption, implementation, and preliminary maintenance. Transport-related adverse events were less frequent during the follow-up observation window than during the baseline period, with events documented in 1 out of 78 transfers (1.28 percent) compared to 12 out of 76 transfers (15.79 percent) prior to guideline implementation.

The study authors cautioned that the observed reduction in adverse events represents an exploratory finding that must be interpreted with care due to methodological constraints. These limitations include the relatively short observation period, the small absolute number of adverse events, potential regression to the mean, secular changes occurring over time, and unmeasured confounding inherent to single-center quasi-experimental before-and-after designs. Based on these observations, the researchers concluded that multi-strategy implementation can successfully enhance provider knowledge and guideline adherence, while calling for multicenter studies with extended follow-up to evaluate long-term sustainability and generalizability.

Subject of Research: Implementation of evidence-based intrahospital transport guidelines for critically ill pediatric patients

Article Title: Implementation and evaluation of evidence-based intrahospital transport guidelines for critically ill children: a multi-framework implementation study using i-PARIHS and RE-AIM

Article References: Zhang, Y., Zeng, L., Yang, S., Gu, Y., Xiang, J., Dong, J., Xiao, Z., & Tan, Y. (2026). Implementation and evaluation of evidence-based intrahospital transport guidelines for critically ill children: a multi-framework implementation study using i-PARIHS and RE-AIM. BMC Pediatrics. https://doi.org/10.1186/s12887-026-08025-5

Image Credits: AI Generated

DOI: 10.1186/s12887-026-08025-5

Keywords: intrahospital transport, critically ill children, pediatric intensive care unit, emergency department, Shenzhen Children's Hospital, clinical practice guidelines, i-PARIHS framework, RE-AIM framework, protocol adherence, provider knowledge, transport-related adverse events, quasi-experimental study, implementation science, patient handover, risk assessment, team coordination, equipment preparation