Specialist team retrieval of head injured patients: fact, fiction, or formula?
Clare Dieppe1, T Y Milly Lo, Jillian McFadzean
1Emergency Department, The Children's Hospital at Westmead, Locked Bag 4001, Parramatta, Sydney, NSW, 2145, Australia. clared1@chw.edu.au
Insights
The Edinburgh Paediatric Retrieval Team (EPRT) can theoretically reach referring hospitals within a 67-mile radius for head-injured children. This study highlights the need for organizational changes to optimize specialist retrieval services.
Area of Science:
- Emergency Medicine
- Pediatric Trauma Care
- Transport Medicine
Background:
- Paediatric head injury transfers require timely specialist intervention.
- Current retrieval practices and team performance need evaluation for efficiency.
Purpose of the Study:
- To assess the feasibility of the Edinburgh Paediatric Retrieval Team (EPRT) reaching head-injured children within optimal timeframes.
- To determine the maximum theoretical retrieval distance for the EPRT.
Main Methods:
- A prospective audit over 2 years analyzed paediatric head injury transfer times.
- EPRT mobilization and travel times were recorded.
- A novel formula calculated the theoretical maximum retrieval radius.
Main Results:
- The median patient stabilization time was 3.6 hours.
- Referral to neurosurgical services averaged 1 hour.
- The EPRT's median mobilization time was 1 hour.
- The theoretical maximum retrieval radius was calculated to be 67 miles.
Conclusions:
- Specialist retrieval of paediatric head injuries is feasible but requires organizational improvements.
- Early patient referral and utilizing mobilization time as a cancellation window are crucial.
- The developed formula can help other teams assess and develop their services.
Objective:
This feasibility study aimed to determine the maximum theoretical distance the Edinburgh Paediatric Retrieval Team (EPRT) could travel to retrieve head injured children without additional delay in reaching definitive care.
Design:
A prospective audit was conducted over 2 years to determine the current practice for paediatric head injury transfers (stabilisation, referral, and transfer time) undertaken by primary hospital staff, and the performance (mobilisation and travel time) of the EPRT. A novel formula was devised and used to determine the theoretical maximum radius within which the EPRT could reach a referring hospital during their stabilisation of head injured patients.
Measurements And Results:
During the study period, 27 head injured patients were transferred to our unit by road and the EPRT conducted 194 road retrievals. The median stabilisation time for the head injured patients was 3.6 h. Median time to refer these patients to neurosurgical services was 1 h after presenting to primary hospitals. Median mobilisation time for EPRT was 1 h. Using our novel formula, 67 miles was the theoretical maximum radius within which the EPRT could reach a referring hospital during their stabilisation of head injured patients.
Conclusions:
Specialist team retrieval of paediatric head injury is a possibility, but not without significant organisational changes such as availability of second teams, early referral of patients and utilisation of the mobilisation time as a cancellation window. Our novel formula offers other teams a starting point to assess their own performance and to develop services.
