# The perception of safety regarding the transfer of infants from the neonatal intensive care unit to a level II neonatology department: a mixed-method cohort study using a Safety-II approach

## TL;DR

This study explores how safe stakeholders perceive the transfer of infants from a NICU to a lower-level neonatology department, finding that communication and timing are key to safety perceptions.

## Contribution

The study introduces a mixed-method approach grounded in Safety-II principles to evaluate perceived safety in neonatal transfers.

## Key findings

- All stakeholder groups reported a positive overall perception of safety during infant transfers.
- Stakeholder perceptions varied significantly across different transfer phases.
- Effective communication, parental involvement, and optimal timing were identified as key facilitators of perceived safety.

## Abstract

This study aimed to investigate the perceived safety during the transfer process of infants from a Neonatal Intensive Care Unit (NICU) to a regional level II department. It sought to identify stakeholder agreements and divergences on safety and to determine the facilitators and barriers to achieving a high level of perceived safety.

This study employed a mixed-method cohort design and action research approach grounded in Safety-II principles.

The study focused on transfers from a single Dutch university hospital NICU to multiple regional level II neonatology departments.

Surveys were administered to parents and care professionals, including NICU staff, level II department staff, and ambulance personnel. The surveys consisted of both quantitative and open-ended questions. Data were analysed quantitatively and qualitatively, incorporating Safety-I and Safety-II perspectives, to assess the perceived safety and identify facilitators and barriers.

A total of 46 transfers were evaluated by 239 stakeholders. The overall perception of safety was positive among all stakeholder groups. There were no significant differences in the overall level of perceived safety between parents and care professionals. However, stakeholder perceptions varied significantly across transfer phases. Qualitative analysis revealed facilitators and barriers related to timing, parental participation and information exchange.

This study indicated consistently positive safety perceptions among parents and care professionals. Effective communication, parental participation and optimal timing were identified as crucial for enhancing safety perceptions during transfers.

The online version contains supplementary material available at 10.1186/s12887-025-05537-4.