Implementation of Direct Admission to the Operating Room Procedure for Children Transported With Airway Emergencies

Children with airway emergencies, such as aspirated foreign bodies (FBs), who present to community emergency departments usually require expeditious transfer to centers with pediatric expertise. In 2018, our hospital's transport team implemented a multidisciplinary direct admission to the operating room (OR) protocol for children transferred for emergent surgical intervention, which bypassed typical hospital entry points. We aimed to assess its impact on time to definitive care and patient outcomes.

We performed a retrospective chart review of all patients aged ≤18 years with suspected aspirated FB transferred to our institution for emergent surgical intervention between July 1, 2013 and March 1, 2023. We determined whether they were taken to the OR post-transfer after first being evaluated in our pediatric emergency department/intensive care unit (Standard protocol) or transported directly to the OR by the transport team (OR Transport protocol). Demographics, transport/surgical times, and clinical data were compared between the groups using t-test and Mann-Whitney U test.

Of the 27 children who met the inclusion criteria, 14 (51.9%) were transported via the Standard protocol and 13 (48.1%) via the OR Transport protocol. Demographics, referring hospital characteristics, time of transfer request, need for mechanical ventilation pretransport, and transport mode were not different; rates of critical care transports were higher for the OR Transport group than for the Standard group (P = .016). Compared with the Standard group, the OR Transport group had shorter median (interquartile range) times from transport arrival to start of surgery (8 [0-15.5] vs. 94.5 [25.75-148.75] minutes, P < .001) and from transport dispatch to surgery (103 [64.25-144] vs. 179 [115.5-265] minutes, P = .035). Although not statistically significant, the OR Transport group had a lower hospitalization rate after the surgery compared with the Standard group (38.5% vs. 64.3%).

Implementation of a direct admission to the OR protocol seems to expedite definitive treatment and may be associated with a decreased need for hospitalization for children with airway FBs who require interhospital transport for emergent surgical intervention.