Difficulties encountered in transport of the critically ill child.
A prospective survey of difficulties encountered in 100 pediatric emergency interhospital transfers was undertaken to identify needs for education of referring doctors and of transport service staff, as well as weaknesses in the organization of a pediatric emergency transport service (PETS). Such obstacles to smooth retrieval included administrative difficulties, mistakes in management, and unresolved acute severe physiologic derangements in the child. Three hundred ninety-four problems were found: 24% were preventable by improved education of referring doctors; these included unrecognized needs for ventilatory support, added oxygen, chest x-ray or nasogastric tube, and difficulties with airway selection, placement, and care. Twenty-eight percent were preventable by better PETS organization, education, protocols, or telephone checklists; examples include equipment problems and clinical derangements unrecognized at referral. Difficulties owing to conditions of transport (eg. vibration, dysbarism, and air turbulence) were uncommon (five percent of patients). Regular reviews of performance of all PET services, combined with measures to educate referring doctors, can improve patient outcome.
Henning
R
R
Intensive Care Unit, Royal Children's Hospital, Melbourne, Victoria, Australia.
McNamara
V
V
D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols / Q000592:standards; D003422:Critical Care / Q000379:methods / Q000592:standards*; D004502:Education, Medical, Continuing; D004632:Emergency Medical Services / Q000458:organization & administration / Q000592:standards*; D004634:Emergency Medical Technicians / Q000193:education; D006302:Health Services Research; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008485:Medical Audit; D010043:Outcome and Process Assessment, Health Care; D010360:Patient Transfer / Q000592:standards*; D010372:Pediatrics / Q000592:standards*; D011446:Prospective Studies; D011787:Quality of Health Care; D012017:Referral and Consultation / Q000592:standards; D012720:Severity of Illness Index; D014187:Transportation of Patients / Q000379:methods / Q000592:standards*; D014739:Victoria