title: A cost and outcomes comparison of a novel integrated pediatric air and ground transportation system.
abstract: BACKGROUND
  The purpose of this study is to compare air transportation of critically ill pediatric patients with a mixed air-ground transportation system by evaluating timeliness, safety, and cost. The setting was a tertiary care "hub" center with three outlying-referral "spoke" facilities.
  
  
  METHODS
  Our study included 96 children transported between June and December 1997, with 45% constituting surgical admissions and 55% medical admissions. Data collected at the outlying facilities, en route, and at our institution included vital signs, laboratory values, and Glasgow coma scores. We evaluated transport time, transport cost, Pediatric Risk of Mortality scores, and Pediatric Index of Mortality of the children during transportation using ANOVA statistical analysis. We also compared adverse events in transportation, total hospital length of stay, and mortality at 24 and 72 hours in both the air and ground transport groups to determine differences in predicted and observed mortality.
  
  
  RESULTS
  A total of 96 children were transported (48% by ground and 52% by air) between June and December 1997. The time at the referring facility was significantly shorter in the ground group than in the air group (air, 55.4 minutes versus ground, 36.7 minutes, p < 0.01). Total transport time differed by only 27 minutes between groups. No difference was identified in morbidity or mortality between air and ground groups. Actual mortality was not significantly different from predicted mortality in either group. The cost of ground transportation was significantly lower (air, $4,236 versus ground, $1,566). When our system of a combined air and ground group transport system is compared with a hypothetical 100% air transport system, we saved an average of more than $240,000 annually.
  
  
  CONCLUSIONS
  We have demonstrated that a "hub-and-spoke" ground transportation system supplements air transportation in a safe, timely, and cost-effective manner.
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Shawn D
authors.initials: SD
authors.lastname: Safford
authors.forename: Thomas Z
authors.initials: TZ
authors.lastname: Hayward
authors.forename: Kristine M
authors.initials: KM
authors.lastname: Safford
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Georgiade
authors.forename: Henry E
authors.initials: HE
authors.lastname: Rice
authors.forename: Michael A
authors.initials: MA
authors.lastname: Skinner
mesh_terms: D017732:Air Ambulances; D000552:Ambulances; D000704:Analysis of Variance; D003365:Costs and Cost Analysis; D016638:Critical Illness; D006801:Humans; D010372:Pediatrics; D014187:Transportation of Patients / Q000191:economics* / Q000379:methods*