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Difficulties encountered in transport of the critically ill child
1Intensive Care Unit, Royal Children's Hospital, Melbourne, Victoria, Australia.
Insights
Improving pediatric emergency transport services requires better education for referring doctors and enhanced organizational protocols. Addressing preventable issues in interhospital transfers significantly improves patient outcomes.
Area of Science:
- Pediatric Emergency Medicine
- Healthcare Systems Analysis
- Transport Medicine
Background:
- Interhospital transfers of pediatric patients present unique challenges.
- Effective pediatric emergency transport services (PETS) are crucial for optimizing patient care during transfers.
- Identifying obstacles in these transfers is key to improving outcomes.
Purpose of the Study:
- To identify difficulties encountered during pediatric emergency interhospital transfers.
- To pinpoint areas for educational improvement for referring physicians and transport staff.
- To assess organizational weaknesses within a pediatric emergency transport service.
Main Methods:
- A prospective survey was conducted on 100 pediatric emergency interhospital transfers.
- Data collection focused on obstacles, including administrative issues, management errors, and physiological derangements.
- Problems were categorized by preventability through education or organizational changes.
Main Results:
- 394 problems were identified across 100 transfers.
- 24% of problems were preventable with improved referring doctor education (e.g., unrecognized needs for ventilation, oxygen, X-rays, NG tubes, airway management).
- 28% were preventable by enhanced PETS organization, education, protocols, or checklists (e.g., equipment issues, unrecognized clinical derangements).
Conclusions:
- Pediatric emergency interhospital transfers face administrative, management, and clinical challenges.
- Significant improvements in patient outcomes are achievable through targeted education of referring doctors and enhanced PETS organization.
- Regular performance reviews and educational initiatives are vital for optimizing pediatric transport services.
Abstract:
A prospective survey of difficulties encountered in 100 pediatric emergency interhospital transfers was undertaken to identify needs for education of referring doctors and of transport service staff, as well as weaknesses in the organization of a pediatric emergency transport service (PETS). Such obstacles to smooth retrieval included administrative difficulties, mistakes in management, and unresolved acute severe physiologic derangements in the child. Three hundred ninety-four problems were found: 24% were preventable by improved education of referring doctors; these included unrecognized needs for ventilatory support, added oxygen, chest x-ray or nasogastric tube, and difficulties with airway selection, placement, and care. Twenty-eight percent were preventable by better PETS organization, education, protocols, or telephone checklists; examples include equipment problems and clinical derangements unrecognized at referral. Difficulties owing to conditions of transport (eg. vibration, dysbarism, and air turbulence) were uncommon (five percent of patients). Regular reviews of performance of all PET services, combined with measures to educate referring doctors, can improve patient outcome.