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

Prakadeshwari Rajapreyar1, Karen Marcdante, Liyun Zhang

  • 11Department of Pediatrics, Section of Pediatric Critical Care, Medical College of Wisconsin, Milwaukee, WI. 2Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.

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Summary

Pediatric critical care physicians show significant discordance in deciding how to dispatch transport teams. Standardized training is needed to improve decision-making consistency for pediatric emergency transport.

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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.