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Effect of patient- and team-related factors on stabilization time during pediatric intensive care transport
Emma L Borrows1, Daniel H Lutman, Mary A Montgomery
1Children's Acute Transport Service (CATS), London, United Kingdom.
Insights
Intensive care retrieval teams spend variable time stabilizing critically ill children, influenced by patient and transport factors. Early interventions do not worsen outcomes, supporting a departure from the "scoop and run" model.
Area of Science:
- Pediatric Critical Care Medicine
- Transport Medicine
- Healthcare Operations Research
Background:
- Interhospital transport of critically ill children requires stabilization.
- The duration of pre-transport stabilization is a critical factor in retrieval services.
- Optimizing stabilization time is essential for efficient patient care and resource allocation.
Purpose of the Study:
- To investigate patient and transport factors affecting stabilization time for critically ill children by retrieval teams.
- To determine the relationship between stabilization duration and patient outcomes post-intensive care unit (ICU) admission.
Main Methods:
- Analysis of prospectively collected data from a UK-based pediatric intensive care retrieval service.
- Inclusion of critically ill children transported over a two-year period.
- Univariate and multivariate analyses to identify factors influencing stabilization time and patient outcomes.
Main Results:
- Patient acuity was high, with 84% invasively ventilated and 28% on vasoactive agents.
- Factors independently affecting stabilization time included predicted mortality risk (Pediatric Index of Mortality 2 score), diagnostic category, team response time, and number of major interventions.
- Each minor intervention increased stabilization time by approximately 10 minutes.
Conclusions:
- Stabilization time is multifactorial, influenced by patient condition and transport logistics.
- Stabilization time alone is not a reliable measure of retrieval team efficiency.
- Early interventions during stabilization do not negatively impact early patient outcomes, challenging the necessity of the "scoop and run" approach in pediatric interhospital transport.
Objectives:
To examine the effects of patient- and transport-related factors on the time spent at the referring hospital by an intensive care retrieval team to stabilize critically ill children and to study the relationship between stabilization time and patient outcome.
Design:
: Analysis of prospectively collected data during pediatric intensive care transport.
Setting:
A dedicated regional pediatric intensive care retrieval service performing interhospital transports in England.
Patients:
Critically ill children transported to intensive care units over a 2-yr period between April 1, 2006 and March 31, 2008.
Interventions:
None.
Measurements And Main Results:
Factors related to the patient (age group, diagnostic category, and severity of illness) and transport (time of referral, team response time, and number of major and minor interventions performed) were analyzed for their effect on stabilization time in univariate and multivariate analyses. The relationship between stabilization time and patient outcome in the first 24 hrs post intensive care unit admission was also studied. Patient acuity was high in the transported population (84% invasively ventilated; 28% on vasoactive agents). Predicted mortality risk (Pediatric Index of Mortality 2 score), diagnostic category, team response time, and number of major interventions performed had an independent effect on stabilization time, whereas the length of stabilization itself did not influence early mortality on the intensive care unit. Each minor intervention prolonged the stabilization time by an average of 10 mins.
Conclusions:
Stabilization time during intensive care transport is influenced by a number of patient- and transport-related factors, and cannot be used in isolation as an indicator of team efficiency. Time spent undertaking intensive care interventions early in the course of patient illness at the referring hospital does not worsen patient outcome, suggesting that the "scoop and run" model can be safely abandoned in interhospital transport.
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