Critical Transitions

How can addressing critical transitions improve health outcomes?

Transitions in care present some of the most challenging events for infants, families, and care teams. Transitions are vulnerable periods, and if not well planned and orchestrated, may result in harm.

Infants requiring intensive and complex care have magnified vulnerability, in part due to the large volume of transitions they experience.

When care transitions at shift change, when patients are transferred, or when care teams change, opportunities for communication breakdowns occur. Data shows that when information degrades because of ineffective handoffs, it strongly increases the potential for medical errors.

We believe that high quality transitions in care positively impact the quality, safety, value, and patient and family experience of care.

The resources below are designed to help you and your team determine how improving critical transitions can affect health outcomes at your center.

PBPs for CLD transitions

Clinical Example: Chronic Lung Disease

Using chronic lung disease as an example, we explore how a focus on transitions supports quality improvement that will positively impact on clinical potentially better practices (PBPs) and improved health outcomes.

See the full example of clinical Potentially Better Practices for primary drivers of effective critical transitions related to chronic lung disease.

Identify Areas of Improvement for Your Center

See Potentially Better Practices for Critical Transitions and Example Areas for Improvement within Phases of Care

VON data items mapped to phases of care

  • To prepare, have access to your 2019 VON data report in Nightingale
  • For each data item, if your center is not within the best 50th percentile compared to the Network average, or if your data is not meeting your local target, circle or highlight that data item on the form
  • Then, review the checkmarks that map data items with opportunities for improvement, to the phases of care
  • On the last page, tally the checkmarks associated with data of interest to your team under each of the phases of care
  • See VON data items mapped to phases of care.

Discernment Worksheet

Critical Transitions, Quality Circle, and iNICQ/NICQ introductory webinar

Consultation with program staff and faculty

  • Email Sonia Darrow, Program Assistant, at with questions or to schedule a consultation to aid your decision to participate in NICQ or iNICQ for critical transitions.

See How Other Teams Have Achieved Improvement Goals Related to Critical Transitions

Teams present improvement stories during the Improvement Science Expo and Annual Quality Congress. See how the team at Children’s Hospital of Illinois worked with referring hospitals to standardize communications and care during transport to improve respiratory, nutritional, and developmental outcomes in <32 week neonates, learn about the Providence Portland Medical Center NICU team’s experience initiating Experience-Based Co-Design (EBCD), and view other stories of improvement in the VON Improvement Library.

Resources to Engage Senior Leaders and Team Members at Your Center

Critical Transitions flyer with comparison of NICQ vs iNICQ features

PowerPoint presentation for leadership – Coming Soon.

VON Quality Improvement Collaboratives

iNICQ for Critical Transitions: Online education and discussion supports improvement, included in Quality Circle membership.

NICQ: Two-year collaborative in small groups to support sharing and collaboration, includes all Quality Circle benefits.