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Transport for paediatric intensive care. Measuring the performance of a specialist transport service
Insights
Critically ill children can be safely transported to a pediatric intensive care unit (PICU) by a specialized team. Transferring children via a PICU team showed no deaths or major deterioration during transit.
Area of Science:
- Pediatric critical care medicine
- Patient transport safety
- Healthcare quality improvement
Background:
- Transferring critically ill children to a pediatric intensive care unit (PICU) requires careful assessment.
- Existing scoring systems may not fully predict the interventions needed during transport.
- Ensuring patient safety and physiological stability during inter-facility transfer is paramount.
Purpose of the Study:
- To evaluate the safety and physiological impact of inter-facility transport for critically ill children.
- To assess the utility of the Pediatric Risk of Mortality (PRISM) and Therapeutic Intervention Scoring System (TISS) scores in predicting transport needs.
- To determine if a specialist PICU team can safely manage critically ill children during transport.
Main Methods:
- Prospective study involving 50 children referred for PICU transport.
- Utilized PRISM scores at referral, pre-transfer, and on PICU arrival.
- Employed TISS scores for interventions by referring and transport teams, recording critical events.
Main Results:
- Three children died before transport; 47 were successfully transported by the PICU team.
- No deaths, major physiological deterioration, or equipment-related issues occurred during transit.
- Physiology scores remained stable throughout the transfer process.
- Referral PRISM scores did not reliably predict the need for pre-transfer interventions by the transport team.
Conclusions:
- Specialist PICU teams can safely transport critically ill children.
- Physiological stability is maintained during specialist-led PICU transfers.
- Current referral scoring systems may not fully anticipate the dynamic needs during transport, highlighting the value of expert clinical judgment.
Abstract:
Fifty children were referred for transport to a paediatric intensive care unit (PICU). Two scoring systems were used for the transfer process. A physiology score derived from the paediatric risk of mortality (PRISM) score was performed at referral, before transfer and on arrival on PICU. An interventions score based on the therapeutic intervention scoring system (TISS) was performed for interventions by the referring staff and by the transport team before and during transfer. Critical events during transport were recorded. Three children died at the referring hospital. Forty-seven were transported by the PICU team. No child died or suffered a major physiological deterioration or equipment related problem in transit. Physiology scores did not deteriorate during transfer. Referral physiology scores did not reliably predict the need for major therapeutic interventions by the transport team before transfer. Critically ill children may be transported safely by a specialist team.
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