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Critical care interhospital transports: predictability of the need for a pediatrician
1Children's Hospital of Alabama, Birmingham 35233.
Insights
Pediatric critical care transport teams can accurately predict the need for a physician before interhospital transfers. This allows for optimized resource allocation in mobile intensive care units, ensuring appropriate physician presence for critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Emergency Medical Services
- Healthcare Operations
Background:
- The Children's Hospital of Alabama utilizes a specialized transport system for critically ill pediatric patients.
- The standard transport team includes a pediatrician, pediatric emergency nurse, and respiratory therapist.
- The necessity of physician presence during interhospital pediatric transfers requires evaluation for resource optimization.
Purpose of the Study:
- To assess the accuracy of pre-transport physician need determination for critically ill pediatric patients.
- To evaluate the feasibility of predicting physician requirements in advance for mobile intensive care unit (MICU) transfers.
Main Methods:
- A prospective study analyzed 148 interhospital transports of critically ill pediatric patients over eight months.
- Transport physicians conducted pre-assessment evaluations to determine the need for physician presence.
- Post-assessment evaluations were performed after transport completion to compare with initial predictions.
Main Results:
- In 73% of transports (108/148), there was minimal or no change in the assessed need for a physician.
- Pre-transport predictions accurately reflected the actual need for physician involvement in the majority of cases.
- Only 2% of transports (3/148) showed a significant increase in the actual need for a physician compared to the prediction.
Conclusions:
- Accurate prediction of physician necessity for pediatric critical care transport is feasible.
- Pre-transport assessments enable effective resource allocation, potentially reducing unnecessary physician deployment.
- This predictive capability supports efficient management of mobile intensive care unit services for pediatric patients.
Abstract:
The Children's Hospital of Alabama Critical Care Transport System provides a mobile intensive care unit for interhospital transfer of critically ill pediatric patients. The transport team consists of a pediatrician, a pediatric emergency nurse, and a respiratory therapist. We studied whether it was possible to determine in advance whether it was always necessary for a physician to be on the team. The transport physician made a determination of need for a physician based on data available prior to transport (preassessment). After the transport was completed, the physician made a retrospective determination of actual need for a physician (postassessment). Over a period of eight months, 148 questionnaires were analyzed. In 108 transports (73%), there was minimal or no change in need for a physician between the pre- and posttransport assessments. Therefore, an accurate prediction of need for a physician was possible in advance. Of the remaining transports in which the determination was significantly changed, 37 (25%) indicated a decrease in actual need for a physician after completion of the transport. There was a significant increase over the prediction in the actual need for a physician in only three cases (2%).