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Impact of physician-less pediatric critical care transport: Making a decision on team composition
Atsushi Kawaguchi1, Charlene C Nielsen2, L Duncan Saunders3
1Department of Pediatrics, Pediatric Critical Care Medicine, University of Alberta, Canada; School of Public Health, University of Alberta, Canada.
Insights
Pediatric critical care transport without a physician showed no difference in patient outcomes. Team composition selection was influenced by clinical factors, but physician variability persisted.
Area of Science:
- Pediatric critical care
- Transport medicine
- Healthcare management
Background:
- Physician presence during pediatric critical care transport has been standard.
- The use of physician non-accompanying teams is an evolving model.
- Understanding the impact and selection factors for different transport teams is crucial.
Purpose of the Study:
- To evaluate the impact of physician non-accompanying pediatric critical care transport.
- To identify factors influencing the choice of transport team composition.
Main Methods:
- Comparison of two eras: Physician-Accompanying Transport (PT) and Physician-Less Transport (PLT).
- Analysis of transport and Pediatric Intensive Care Unit (PICU) outcomes for children transported to a Canadian academic children's hospital.
- Multivariable logistic regression used to identify factors associated with team selection in the PLT-era.
Main Results:
- The Physician-Less Transport (PLT)-era (N=1177) showed a significantly lower probability of PICU admission compared to the Physician-Accompanying Transport (PT)-era (N=1490).
- No significant differences in patient outcomes, including mortality, were observed between the eras.
- Specific transport characteristics were associated with the selection of a physician non-accompanying team, with notable variability among triage physicians.
Conclusions:
- The increasing use of physician non-accompanying teams did not result in significant differences in patient outcomes.
- Clinical and system factors influenced transport team composition, but significant variation among triage physicians remained.
Purpose:
To explore the impact of a physician non-accompanying pediatric critical care transport program, and to identify factors associated with the selection of specific transport team compositions.
Materials And Methods:
Children transported to a Canadian academic children's hospital were included. Two eras (Physician-accompanying Transport (PT)-era: 2000-07 when physicians commonly accompanied the transport team; and Physician-Less Transport (PLT)-era: 2010-15 when a physician non-accompanying team was increasingly used) were compared with respect to transport and PICU outcomes. Transport and patient characteristics for the PLT-era cohort were examined to identify factors associated with the selection of a physician accompanying team, with multivariable logistic regression with triage physicians as random effects.
Results:
In the PLT-era (N=1177), compared to the PT-era (N=1490) the probability of PICU admission was significantly lower, and patient outcomes including mortality were not significantly different. Associations were noted between the selection of a physician non-accompanying team and specific transport characteristics. There was appreciable variability among the triage physicians for the selection of a physician non-accompanying team.
Conclusions:
No significant differences were observed with increasing use of a physician non-accompanying team. Selection of transport team compositions was influenced by clinical and system factors, but appreciable variation still remained among triage physicians.
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