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Quality Metrics in Neonatal and Pediatric Critical Care Transport: A National Delphi Project
Hamilton P Schwartz1, Michael T Bigham, Pamela J Schoettker
11Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati School of Medicine, Cincinnati, OH. 2Division of Critical Care Medicine, Department of Pediatrics, Akron Children's Hospital, Northeast Ohio Medical University, Akron, OH. 3James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital, Cincinnati, OH. 4Division of Critical Care Medicine, Department of Pediatrics, Miami Children's Hospital, Miami, FL. 5Division of Neonatology, Department of Pediatrics, James W. Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN. 6Department of Pediatrics, Brown University Alpert School of Medicine, Providence, RI.
Insights
Pediatric transport teams now have 12 consensus quality metrics for benchmarking. These metrics will help improve the quality of care during neonatal and pediatric patient transport.
Area of Science:
- Medical Transport Quality Assurance
- Pediatric Healthcare Systems
- Neonatal Critical Care
Background:
- Ensuring quality care during neonatal and pediatric patient transport is crucial for patient outcomes.
- Existing quality indicators for pediatric transport programs lacked national consensus for benchmarking.
- A need existed for standardized metrics to compare transport team performance.
Purpose of the Study:
- To achieve national consensus on essential quality metrics for neonatal and pediatric patient transport.
- To establish a benchmark for evaluating and improving the quality of specialized care during patient transport.
Main Methods:
- A modified Delphi technique was employed, involving electronic surveys and in-person discussions.
- Participants at the American Academy of Pediatrics Section on Transport Medicine Quality Metrics Summit were eligible.
- Consensus was defined as at least 70% agreement among respondents on the importance of a metric.
Main Results:
- Eighty-two candidate quality metrics were initially considered.
- Twelve core quality metrics achieved consensus as "very important" for transport.
- Key metrics include airway management, team mobilization time, patient/crew injuries, and adverse events, with defined parameters for uniform tracking.
Conclusions:
- A diverse group of national transport experts reached consensus on 12 core quality metrics.
- These 12 metrics are proposed for use by transport teams nationwide.
- The established metrics aim to guide quality improvement initiatives and benchmarking efforts in pediatric and neonatal transport.
Objectives:
The transport of neonatal and pediatric patients to tertiary care facilities for specialized care demands monitoring the quality of care delivered during transport and its impact on patient outcomes. In 2011, pediatric transport teams in Ohio met to identify quality indicators permitting comparisons among programs. However, no set of national consensus quality metrics exists for benchmarking transport teams. The aim of this project was to achieve national consensus on appropriate neonatal and pediatric transport quality metrics.
Design:
Modified Delphi technique.
Setting:
The first round of consensus determination was via electronic mail survey, followed by rounds of consensus determination in-person at the American Academy of Pediatrics Section on Transport Medicine's 2012 Quality Metrics Summit.
Subjects:
All attendees of the American Academy of Pediatrics Section on Transport Medicine Quality Metrics Summit, conducted on October 21-23, 2012, in New Orleans, LA, were eligible to participate.
Measurements And Main Results:
Candidate quality metrics were identified through literature review and those metrics currently tracked by participating programs. Participants were asked in a series of rounds to identify "very important" quality metrics for transport. It was determined a priori that consensus on a metric's importance was achieved when at least 70% of respondents were in agreement. This is consistent with other Delphi studies. Eighty-two candidate metrics were considered initially. Ultimately, 12 metrics achieved consensus as "very important" to transport. These include metrics related to airway management, team mobilization time, patient and crew injuries, and adverse patient care events. Definitions were assigned to the 12 metrics to facilitate uniform data tracking among programs.
Conclusions:
The authors succeeded in achieving consensus among a diverse group of national transport experts on 12 core neonatal and pediatric transport quality metrics. We propose that transport teams across the country use these metrics to benchmark and guide their quality improvement activities.
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