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A cost and outcomes comparison of a novel integrated pediatric air and ground transportation system
Shawn D Safford1, Thomas Z Hayward, Kristine M Safford
1Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Insights
A mixed air-ground transport system for critically ill children is safe, timely, and cost-effective. This hub-and-spoke model significantly reduces costs compared to air-only transport, saving over $240,000 annually.
Area of Science:
- Pediatric critical care transport
- Emergency medical services
- Healthcare logistics
Background:
- Critically ill pediatric patients require timely and safe transportation.
- Evaluating mixed air-ground transport systems is crucial for optimizing patient care.
- Tertiary care centers often utilize hub-and-spoke models for patient transfers.
Purpose of the Study:
- To compare air transportation with a mixed air-ground system for critically ill pediatric patients.
- To evaluate the timeliness, safety, and cost-effectiveness of each transport method.
- To analyze the impact on patient outcomes and healthcare resource utilization.
Main Methods:
- A study involving 96 pediatric patients (surgical and medical admissions) transported between June and December 1997.
- Data collection included vital signs, laboratory values, and Glasgow Coma Scores during transport.
- Statistical analysis (ANOVA) compared transport time, cost, morbidity, mortality, and length of stay between air and ground groups.
Main Results:
- Ground transport had significantly shorter time at the referring facility (36.7 min vs 55.4 min).
- Total transport time difference was minimal (27 minutes).
- No significant differences in morbidity or mortality were observed; costs were substantially lower for ground transport ($1,566 vs $4,236).
Conclusions:
- A hub-and-spoke ground transportation system effectively supplements air transport for pediatric patients.
- The mixed system is safe, timely, and demonstrably cost-effective.
- Annual savings of over $240,000 were estimated compared to a hypothetical 100% air transport system.
Background:
The purpose of this study is to compare air transportation of critically ill pediatric patients with a mixed air-ground transportation system by evaluating timeliness, safety, and cost. The setting was a tertiary care "hub" center with three outlying-referral "spoke" facilities.
Study Design:
Our study included 96 children transported between June and December 1997, with 45% constituting surgical admissions and 55% medical admissions. Data collected at the outlying facilities, en route, and at our institution included vital signs, laboratory values, and Glasgow coma scores. We evaluated transport time, transport cost, Pediatric Risk of Mortality scores, and Pediatric Index of Mortality of the children during transportation using ANOVA statistical analysis. We also compared adverse events in transportation, total hospital length of stay, and mortality at 24 and 72 hours in both the air and ground transport groups to determine differences in predicted and observed mortality.
Results:
A total of 96 children were transported (48% by ground and 52% by air) between June and December 1997. The time at the referring facility was significantly shorter in the ground group than in the air group (air, 55.4 minutes versus ground, 36.7 minutes, p < 0.01). Total transport time differed by only 27 minutes between groups. No difference was identified in morbidity or mortality between air and ground groups. Actual mortality was not significantly different from predicted mortality in either group. The cost of ground transportation was significantly lower (air, $4,236 versus ground, $1,566). When our system of a combined air and ground group transport system is compared with a hypothetical 100% air transport system, we saved an average of more than $240,000 annually.
Conclusions:
We have demonstrated that a "hub-and-spoke" ground transportation system supplements air transportation in a safe, timely, and cost-effective manner.
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