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Effect of Transition From a Unit-Based Team to External Transport Team for a Pediatric Critical Care Unit
Brian M Cummings1, Kanakaraju Kaliannan1, Phoebe H Yager1
11 Department of Pediatrics, Pediatric Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA.
Insights
Transitioning to an external pediatric intensive care unit (PICU) transport service maintained transport volume and increased overall PICU admissions. This study provides insights into regionalization impacts on pediatric critical care transport services.
Area of Science:
- Pediatric critical care medicine
- Healthcare management
- Transport medicine
Background:
- Pediatric hospitals face costs and benefits when maintaining specialized transport teams.
- The impact of transitioning to external transport vendors on pediatric intensive care units (PICUs) is not well understood.
- Hospital systems are increasingly focusing on population health management, necessitating data on transport service models.
Purpose of the Study:
- To examine the impact of transitioning from a unit-based transport team to an external vendor on PICU transports.
- To analyze changes in PICU admissions, referrals, and transfers following the transition.
- To evaluate the long-term effects of regionalized transport services on pediatric critical care.
Main Methods:
- A single-center retrospective review of PICU admissions, referrals, and transfers.
- Analysis covered a 9-year period (1999-2012) including baseline, post-transition, and maintenance phases.
- Descriptive statistics and statistical process control charts were used to analyze transfer volume.
Main Results:
- Total PICU admissions increased significantly (3.7% annual growth rate).
- Mean annual transports and referrals remained stable post-transition.
- Initial increases in transport refusals were observed but returned to baseline levels; bed/staffing constraints were primary reasons.
Conclusions:
- Transitioning to a regional transport service maintained PICU transport volume long-term while increasing overall PICU admissions.
- Further research is needed on the cost-benefit and quality of care impacts of transport regionalization.
- Understanding these impacts is crucial for healthcare systems focusing on population management.
Objective:
Pediatric hospitals must consider staff, training, and direct costs required to maintain a pediatric specialized transport team, balanced with indirect potential benefits of marketing and referral volume. The effect of transitioning a unit-based transport team to an external service on the pediatric intensive care unit (PICU) is unknown, but information is needed as hospital systems focus on population management. We examined the impact on PICU transports after transition to an external transport vendor.
Methods:
Single-center retrospective review performed of PICU admissions, referrals, and transfers during baseline, post-, and maintenance period with a total of 9-year follow-up. Transfer volume was analyzed during pre-, post-, and maintenance phase with descriptive statistics and statistical process control charts from 1999 to 2012.
Results:
Total PICU admissions increased with an annual growth rate of 3.7%, with mean annual 626 admissions prior to implementation to the mean of 890 admissions at the end of period, P < .001. The proportion of transport to total admissions decreased from 27% to 21%, but mean annual transports were unchanged, 175 to 183, P = .6, and mean referrals were similar, 186 to 203, P = .8. Seasonal changes in transport volume remained as a predominant source of variability. Annual transport refusals increased initially in the postimplementation phase, mean 11 versus 33, P < .03, but similar to baseline in the maintenance phase, mean 20/year, P = .07. Patient refusals were due to bed and staffing constraints, with 7% due to the lack of transport vendor availability.
Conclusion:
In a transition to a regional transport service, PICU transport volume was maintained in the long-term follow-up and total PICU admissions increased. Further research on the direct and indirect impact of transport regionalization is needed to determine the optimal cost-benefit and quality of care as health-care systems focus on population management.
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