Decision-Making in Pediatric Transport Team Dispatch Using Script Concordance Testing.

Area of Science:

• Pediatric Critical Care Medicine
• Emergency Medical Services
• Healthcare Management

Background:

• Dispatching pediatric transport teams involves complex decision-making.
• Medical Directors, Pediatric Intensivists, and Critical Care fellows often guide these decisions.
• Understanding decision-making processes is crucial for optimizing clinical care, cost-effectiveness, and education.

Purpose of the Study:

• To compare the decision-making processes of Transport Medical Directors with those of Pediatric Intensivists and Critical Care fellows regarding pediatric transport team dispatch.
• To identify factors influencing discordance in dispatch decisions.

Main Methods:

• A survey using Script Concordance Testing guidelines was developed with 15 case vignettes covering 20 scenarios.
• The survey assessed the impact of intrinsic patient factors and extrinsic factors on dispatch decisions.
• Participants included Transport Medical Directors (expert panel), Pediatric Intensivists, and senior Critical Care fellows from accredited programs.

Main Results:

• There was low concordance in decision-making among Transport Medical Directors (median score 33.9%).
• No significant difference in decision-making scores was found between senior fellows and Pediatric Intensivists (p = 0.12).
• Transport Medical Directors showed higher concordance on intrinsic patient factors compared to extrinsic factors.

Conclusions:

• Pediatric critical care physicians exhibit discordance in pediatric transport team dispatch decisions.
• Script Concordance Testing can help identify variations in decision-making standards.
• Developing standardized curricula for pediatric transport dispatch is recommended to improve consistency and outcomes.