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Creating a Pediatric Prehospital Destination Decision Tool Using a Modified Delphi Method

Jennifer F Anders1, Jennifer N Fishe2, Kyle A Fratta1,3

  • 1Department of Pediatrics, Johns Hopkins University, Baltimore, MD 21287, USA.

Children (Basel, Switzerland)
|August 27, 2021
PubMed

Insights

A new evidence-based tool, the Pediatric Destination Tree (PDTree), guides emergency medical services (EMS) in choosing appropriate pediatric specialty hospitals, aiming to reduce transport delays and improve care for critically ill children.

Area of Science:

  • Pediatric Emergency Medicine
  • Healthcare Decision Support Systems
  • Health Services Research

Background:

  • Current emergency medical services (EMS) guidelines for adult patient transport to specialty hospitals lack pediatric equivalents.
  • Transporting children to facilities unable to provide definitive care leads to delayed treatment and potential adverse events.
  • A standardized decision tool is needed to optimize pediatric patient destination choices by EMS.

Purpose of the Study:

  • To develop a novel, evidence-based decision tool to aid emergency medical services (EMS) in selecting appropriate specialty hospitals for pediatric patient transport.
  • To improve the accuracy and efficiency of pediatric patient destination decisions, thereby reducing secondary transports and care delays.

Main Methods:

  • A multidisciplinary expert panel (EP) reviewed pediatric care literature and defined four facility capability levels.
  • A modified Delphi method was employed for the EP to match specific pediatric medical conditions with appropriate facility levels.
  • Iterative voting rounds and consensus-building were used to refine condition-to-facility level assignments and select a visual display format.

Main Results:

  • Seventeen pediatric medical conditions requiring potential secondary transport were identified.
  • Through consensus, the EP assigned specific facility capability levels to nine conditions in the first round, with six additional conditions reaching consensus after a second round.
  • The Pediatric Destination Tree (PDTree) was unanimously approved by the panel in a visual display format.

Conclusions:

  • The developed PDTree is a novel, evidence-based decision support tool designed for EMS use in pediatric patient transport.
  • The tool incorporates multidisciplinary expertise and literature evidence to guide destination choices, aiming to enhance pediatric patient outcomes.
  • Implementation of the PDTree has the potential to standardize and improve the quality of care for critically ill or injured children during emergency transport.

Keywords:
emergency careemergency medical services (EMS)pediatricsprehospitalregionalizationspecialty caretransporttriage

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