Effect of Transition From a Unit-Based Team to External Transport Team for a Pediatric Critical Care Unit

Abstract

Objective:

Pediatric hospitals must consider staff, training, and direct costs required to maintain a pediatric specialized transport team, balanced with indirect potential benefits of marketing and referral volume. The effect of transitioning a unit-based transport team to an external service on the pediatric intensive care unit (PICU) is unknown, but information is needed as hospital systems focus on population management. We examined the impact on PICU transports after transition to an external transport vendor.

Methods:

Single-center retrospective review performed of PICU admissions, referrals, and transfers during baseline, post-, and maintenance period with a total of 9-year follow-up. Transfer volume was analyzed during pre-, post-, and maintenance phase with descriptive statistics and statistical process control charts from 1999 to 2012.

Results:

Total PICU admissions increased with an annual growth rate of 3.7%, with mean annual 626 admissions prior to implementation to the mean of 890 admissions at the end of period, P < .001. The proportion of transport to total admissions decreased from 27% to 21%, but mean annual transports were unchanged, 175 to 183, P = .6, and mean referrals were similar, 186 to 203, P = .8. Seasonal changes in transport volume remained as a predominant source of variability. Annual transport refusals increased initially in the postimplementation phase, mean 11 versus 33, P < .03, but similar to baseline in the maintenance phase, mean 20/year, P = .07. Patient refusals were due to bed and staffing constraints, with 7% due to the lack of transport vendor availability.

Conclusion:

In a transition to a regional transport service, PICU transport volume was maintained in the long-term follow-up and total PICU admissions increased. Further research on the direct and indirect impact of transport regionalization is needed to determine the optimal cost–benefit and quality of care as health-care systems focus on population management.

Keywords

transport pediatric intensive care ICU organization administration

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References

Ajizian

Nakagawa

. Interfacility transport of the critically ill pediatric patient. Chest. 2007;132(4):1361–1367.

McPherson

Graf

. Speed isn’t everything in pediatric medical transport. Pediatrics. 2009;124(1):381–383.

Loehr

Messmer

. The case for specialized transport teams [Viewpoint]. Am J Nurs. 2011;111(9):11.

Flabouris

Seppelt

. Optimal interhospital transport systems for the critically ill. In: Vincent

ed. Yearbook of Intensive Care and Emergency Medicine. New York: Springer, Berlin Heidelberg; 2001:647–660.

Booy

Habibi

Nadel

; Meningococcal Research Group. Reduction in case fatality rate from meningococcal disease associated with improved healthcare delivery. Arch Dis Child. 2001;85(5):386–390.

Wiegersma

Droogh

Zijlstra

Fokkema

Ligtenberg

. Quality of interhospital transport of the critically ill: impact of a mobile intensive care unit with a specialized retrieval team. Crit Care. 2011;15(1):R75.

Orr

Felmet

Han

. Pediatric specialized transport teams are associated with improved outcomes. Pediatrics. 2009;124(1):40–48.

Bion

Wilson

Taylor

. Transporting critically ill patients by ambulance: audit by sickness scoring. BMJ. 1988;296(6616):170–171.

Kanter

Tompkins

. Adverse events during interhospital transport: physiologic deterioration associated with pretransport severity of illness. Pediatrics. 1989;84(1):43–48.

10.

Macnab

Wensley

Sun

Cost-benefit of trained transport teams: estimates for head-injured children. Prehosp Emerg Care. 2001;5(1):1–5.

11.

Edge

Kanter RK, Weigle

Walsh

. Reduction of morbidity in interhospital transport by specialized pediatric staff. Crit Care Med. 1994;22(7):1186–1191.

12.

Barry

Ralston

. Adverse events occurring during interhospital transfer of the critically ill. Arch Dis Child. 1994;71(1):8–11.

13.

Britto

Nadel

Maconochie

. Morbidity and severity of illness during interhospital transfer: impact of a specialized paediatric retrieval team. BMJ. 1995;311(7009):836–839.

14.

Bellingan

Olivier

Batson

Webb

. Comparison of a specialist retrieval team with current United Kingdom practice for the transport of critically ill patients. Intensive Care Med. 2000;26(6):740–744.

15.

Vos

Nissen

Nieman

. Comparison of interhospital pediatric intensive care transport accompanied by a referring specialist or a specialist retrieval team. Intensive Care Med. 2004;30(2):302–308.

16.

Hatherill

Waggie

Reynolds L Argent

. Transport of critically ill children in a resource-limited setting. Intensive Care Med. 2003;29(9):1547–1554.

17.

Hui

Lee

Chan

Tang

Kalinowski

. Measuring performance of night-time interfacility transport service. Eur J Emerg Med. 2012;19(4):264–266.

18.

Woodward

Insoft

Pearson-Shaver

. The state of pediatric interfacility transport: consensus of the second national pediatric and neonatal interfacility transport medicine leadership conference. Pediatr Emerg Care. 2002;18(1):38–43.

19.

Williams

. Innovative approaches to cost containment. Healthc Financ Manage. 2010;64(3):72–78.

20.

Cleverley

. Cost reduction: identifying the opportunities. Healthc Financ Manage. 2010;64(3):52–59.

21.

Kaplan

Porter

. How to solve the cost crisis in health care. Harv Bus Rev. 2011;89(9):46–61.

22.

Luke

. Health care in the United States: current and future challenges. Manag Care. 2001;10(10 suppl):2–6.

23.

Sajjanhar

Tibby

Hatherill

Marsh

Murdoch

. A paediatric retrieval service: its effect on clinical efficacy, activity and resource use in a tertiary paediatric intensive care unit. Clin Intensive Care. 1997;8:178–181.

24.

Stroud

Trautman

Meyer

. Pediatric and neonatal interfacility transport: results from a national consensus conference. Pediatrics. 2013;132(2):359–366.

25.

Commission on Accreditation of Medical Transport Systems. Accreditation Standards of Commission on Accreditation of Medical Transport Systems. 5th ed. Sandy Springs, SC: Commission on Accreditation of Medical Transport Systems; 2002.

26.

Harrison

Thomas

Wedel

. Success rates of pediatric intubation by a non-physician-staffed critical care transport service. Pediatr Emerg Care. 2004;20(2):101–107.

27.

Ramnarayan

Thiru

Parslow

Harrison

Draper

Rowan

. Effect of specialist retrieval teams on outcomes in children admitted to paediatric intensive care units in England and Wales: a retrospective cohort study. Lancet. 2010;376(9742):698–704.

28.

The Emergency Medical Treatment and Active Labor Act of 1986, Section 1867(a) of the Social Security Act, passed as part of the Consolidated Omnibus Budget Reconciliation Act of 1986. Pub.L. No. 99-272, § 9121, 100 Stat. 82: 164–167.

29.

Davis

Rodewald

. Use of EMS for seriously ill children in the office: a survey of primary care physicians. Prehosp Emerg Care. 1999;3(2):102–106.

30.

Ramnarayan

. Measuring the performance of an inter-hospital transport service. Arch Dis Child. 2009;94(6):414–416.