Assessment of interhospital transport care for pediatric patients

Abstract

Background: Many critically ill patients require transfer to a higher-level hospital for complex medical care. Despite the publication of the American Academy of Pediatrics guidelines for pediatric interhospital transportation services and the establishment of many pediatric transport programs, adverse events during pediatric transport still occur.Purpose: To determine the incidence of adverse events occurring during pediatric transport and explore their complications and risk factors.Methods: This prospective observational study explored the adverse events that occurred during the interhospital transport of all pediatric patients referred to the pediatric intensive care unit of Ramathibodi Hospital between March 2016 and June 2017.Results: There were 122 pediatric transports to the unit. Adverse events occurred in 25 cases (22%). Physiologic deterioration occurred in 15 patients (60%). Most issues (11 events) involved circulatory problems causing patient hypotension and poor tissue perfusion requiring fluid resuscitation or inotropic administration on arrival at the unit. Respiratory complications were the second most common cause (4 events). Equipmentrelated adverse events occurred in 5 patients (20%). The common causes were accidental extubation and endotracheal tube displacement. Five patients had both physiologic deterioration and equipment-related adverse events. Regarding transport personnel, the group without complications more often had a physician escort than the group with complications (92% vs. 76%; relative risk, 2.4; <i>P</i>=0.028).Conclusion: The incidence of adverse events occurring during the transport of critically ill pediatric patients was 22%. Most events involved physiological deterioration. Escort personnel maybe the key to preventing and appropriately monitoring complications occurring during transport.

Adverse events during intra-hospital transport of critically ill patients: an observational study

“…The results of this study indicated that device preparation was the dominant factor for AEs during the transfer of critically ill patients from the emergency room to the intensive care unit. These results are in line with other studies, which state that adverse events that occur during intrahospital transportation are caused by the unavailability of equipment (Chaichotjinda et al, 2020). Adequate equipment preparation increases patient safety and security during intra-hospital transfers (Swickard et al, 2018).…”

Pediatric Critical Care Transport

“…In a study done in Thailand, the main diagnostic categories that required transport to a higher level of care were neurological conditions, respiratory, hematooncologic, and cardiac illness. 22 In countries like the United States, 1 study reported that asthma, epilepsy, and diabetes mellitus were the most common pediatric interfacility transport diagnosis, and children aged 0 to 4 years were the ones that were more commonly transferred to another facility than patients from another age group. In this study, they applied an interfacility transport rate, and the 3 categories with the highest rate were diabetes mellitus, appendicitis, and internal obstruction.…”

Association between emergency department pediatric readiness and transfer of noninjured children in small rural hospitals

“…While necessary in some cases for optimal patient health, the transfer process may put the patient at risk for adverse events. Patients often undergo repeated, unnecessary laboratory and radiologic tests at the destination hospital, 6–9 which sometimes place significant emotional and financial burdens on the patient's family. These considerations are particularly relevant for rural families given the additional travel and lodging needs 4 …”

“…Several professional organizations recognized the pediatric‐specific challenges of emergency care and formed the National Pediatric Readiness Project (NPRP), a multiphase quality improvement collaborative aimed at improving pediatric emergency care. The NPRP established a survey‐based quantitative measure of pediatric readiness that evaluates ED compliance with the 2009 “Guidelines of Care of Children in the Emergency Department.” 10 Recent studies have found that EDs with increased pediatric readiness were associated with decreased hospital length of stay and decreased mortality 7,11 …”