Impact of Interfacility Transport Method and Specialty Teams on Outcomes of Pediatric Trauma Patients

Patel, Shetal C.; Murphy, Stephen P.; Penfil, Scott; Romeo, Debra; Hertzog, James H.

doi:10.1097/pec.0000000000001167

Cited by 9 publications

(1 citation statement)

References 9 publications

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“…Currently, no evidence-based pediatric guidelines exist that define the requirement for physician presence on interfacility transports, the ideal mode of transportation, or limitations of mobilization and travel times to and from outside facilities due, in part, to the paucity of studies in this field [1][2][3][4]. However, several reports suggest that the outcomes of children improve when they are transported by specialty pediatric transport teams rather than basic emergency medical services [5][6][7], as evidenced by improved mortality rates and decreased frequency of adverse events during transport [6,[8][9][10]. Non-physician transport team members have shown strong potential in providing procedural interventions, such as high successful intubation rates of 95-100% [11,12].…”

Section: Introductionmentioning

confidence: 99%

Pediatric interfacility transport effects on mortality and length of stay

et al. 2021

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Background We aimed to evaluate the effects of interfacility pediatric critical care transport response time, physician presence during transport, and mode of transport on mortality and length of stay (LOS) among pediatric patients. We hypothesized that a shorter response time and helicopter transports, but not physician presence, are associated with lower mortality and a shorter LOS. Methods Retrospective, single-center, cohort study of 841 patients (< 19 years) transported to a quaternary pediatric intensive care unit and cardiovascular intensive care unit between 2014 and 2018 utilizing patient charts and transport records. Multivariate linear and logistic regression analyses adjusted for age, diagnosis, mode of transport, response time, stabilization time, return duration, mortality risk (pediatric index of mortality-2 and pediatric risk of mortality-3), and inotrope, vasopressor, or mechanical ventilation presence on admission. Results Four hundred and twenty-eight (50.9%) patients were transported by helicopter, and 413 (49.1%) were transported by ambulance. Physicians accompanied 239 (28.4%) transports. The median response time was 2.0 (interquartile range 1.4–2.9) hours. Although physician presence increased the median response time by 0.26 hours (P = 0.020), neither physician presence nor response time significantly affected mortality, ICU length of stay (ILOS) or hospital length of stay (HLOS). Helicopter transports were not significantly associated with mortality or ILOS, but were associated with a longer HLOS (3.24 days, 95% confidence interval 0.59–5.90) than ambulance transports (P = 0.017). Conclusions These results suggest response time and physician presence do not significantly affect mortality or LOS. This may reflect the quality of pre-transport care and medical control communication. Helicopter transports were only associated with a longer HLOS. Our analysis provides a framework for examining transport workforce needs and associated costs.

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Section: Introductionmentioning

confidence: 99%

Pediatric interfacility transport effects on mortality and length of stay

et al. 2021

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Team Models in Interfacility Transport-Building and Maintaining Competencies

Whyte

Narvey²

2017

Curr Treat Options Peds

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Interfacility transport I Transport teams I Mobile intensive care I Safety and system design Opinion statementPurpose of review Transport teams have evolved their capability to provide mobile intensive care units to optimize patient outcomes in most regionalized systems of health care. Our goal was to review the current literature to determine the best model of practice for interfacility transport and the specific training required to achieve and maintain competencies in transport medicine. Recent findings The literature remains largely consensus based and experiential, and there has been little development in the 'state of the art' over the past 5 years. Transport practitioners, regardless of their professional backgrounds, must acquire numerous skills to meet the needs of the patient, owing to the unique and dynamic nature of each transport. The broader their scope of practice, the larger the range of competencies they must acquire. A critical volume of patients is required to maintain standards and performance especially for technical skills. Thus, teams should be specialized in the care of specific patient populations, as well as the field of transport processes, safety, and system design. Summary For teams to be dedicated to the transport service, we often need to combine neonatal, (with or without high-risk mothers) with paediatric volumes, to ensure a critical mass of patients to build and maintain competencies. Ideally, a collaborative practice team model is created to facilitate this, with clinicians from different health care backgrounds and areas of practice. This permits the collective sum of its members' individual skills and abilities, facilitates cross training of all, and provides maximum flexibility for the team. Teams should be located at tertiary level hospitals for ready access to education and practical skills but should be centrally coordinated and dispatched for greatest efficiencies, and integration of air and land modalities. 'On-line' medical control provided by an experienced consultant and expert in transport medicine, together with transport policies and procedures, must be in place to guide performance and ensure optimal outcomes. Regular debriefing, extensive transport reviews, and a database help determine each individual's educational needs. Trends in key team performance indicators allow for benchmarking and help drive better performance.

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Establishing a Combined Neonatal and Paediatric Transport System From Scratch

Hancock

Harrison²

2018

Curr Treat Options Peds

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Purpose of review Centralisation of neonatal and paediatric intensive care over the last 30 years has led to a significant increase in the numbers of newborn babies and children requiring interfacility transport. Many early ad hoc transport teams have evolved into specialised services providing mobile ICUs capable of providing state of the art critical care. This paper focuses on the development of combined neonatal and paediatric transport teams which has been driven by a pragmatic analysis of the benefits flowing from critical mass, economics and clinical cross fertilisation. Recent findings There is a growing body of evidence that specialist transport teams have better outcomes in terms of morbidity and mortality; however, anecdotal evidence would suggest that the benefits of a combined team are somewhat counterbalanced by the significant challenges of the wide scope of care and logistical complexity. Summary Establishing a combined service requires vision, time, hard work and support from the clinical and health care commissioning communities. Success of the project will depend on strong clinical leadership, a dedicated highly skilled group of professionals who share the vision, financial support and a foundation based on quality and safety. Given the high risk nature of the activity, any new service will need to benchmark against recognised standards and key performance metrics to ensure the best care possible is provided to this most vulnerable group of patients.

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Impact of Interfacility Transport Method and Specialty Teams on Outcomes of Pediatric Trauma Patients

Cited by 9 publications

References 9 publications

Pediatric interfacility transport effects on mortality and length of stay

Pediatric interfacility transport effects on mortality and length of stay

Team Models in Interfacility Transport-Building and Maintaining Competencies

Establishing a Combined Neonatal and Paediatric Transport System From Scratch

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