For many clinicians, the decision on whether a child needs a nurse escort during hospital transfer has often come down to clinical judgment. While built on experience, there was no validated tool to back up the decision, until now.
The PaNURAMA (Paediatric Non-Urgent Risk Assessment Management and Nurse Escort Assessment) project, led by emergency physician Dr Michelle Davison, set out to develop and validate a structured risk stratification tool for non-urgent paediatric inter-hospital transfers.
“We knew from practice which children needed extra care during transfer, but we needed data to prove it,” Dr Davison shared. “This study shows PaNURAMA can support clinicians to make informed, consistent decisions.”
The tool uses a three-tier system, Red (urgent risk), Amber (moderate risk), and Green (low risk), to guide decisions around consultation and escort requirements.
Key FindingsA validation study of 158 inter-hospital transfers confirmed the tool’s accuracy and reliability, with 94% agreement between pre- and post-transfer risk. It correctly identified when a nurse escort was needed 82% of the time and when not needed 97% of the time. It also showed high consistency when used by the same clinician, supporting its reliability in real-world decision-making.
Case reviews confirmed changes in risk category were clinically appropriate and often reflected improvements following initial treatment.
Changing Practice“It was really reassuring to see that our gut instincts were right,” Dr Davison said. “The tool worked well, but it also showed us where we needed to improve training to ensure everyone uses it the same way.”
PaNURAMA is now embedded across the SCHHS, spanning hospitals in Nambour, Gympie, Maleny, Noosa, and Buderim. It has reduced unnecessary nurse escorts, freed up staff for other essential work, and improved patient flow without compromising safety.
The research also led to the development of training resources and protocols to support consistent implementation.
“We were able to give clinicians clearer information around what the QAS can provide during transfer and when additional support is or isn’t needed,” Dr Davison outlined. “This helps everyone make more informed, confident decisions.”Next steps
The team is now adapting the PaNURAMA tool for use in regional, rural and remote centres, where distance and access to care remain challenging. It is also being integrated into broader inter-facility transfer improvement efforts, including the SWIFTKids (Standardised Workflow for Inter-Facility Transfer of Kids) project, supported by the Children’s Hospital Foundation.
“This is about improving equity in care,” said Dr Davison. “Every child deserves to receive the same safe, high-quality care, no matter where they present.”