title: Impact of a triage tool on air versus ground transport of cardiac patients to a tertiary center.
abstract: BACKGROUND
  The optimum method of transport for acute cardiac patients remains controversial. We proposed a physician-developed triage scheme for appropriate use of air versus mobile intensive care unit (ICU) in the transfer of cardiac patients and sought to determine the impact on the distribution of transport mode for cardiac patients in areas of personal characteristics and clinical factors and whether the triage scheme would be a valuable decision-making tool for physicians referring cardiac patients to tertiary centers.
  
  
  METHODS
  This was a prospective, observational study of transport mode for cardiac patients transported to a tertiary care facility. A comparison was conducted with historical controls. The intervention studied was an educational program designed to teach a triage decision tool developed by a receiving cardiologist with input from the critical care transport team. Short-distance (less than 30 minutes) and long-distance transports were examined. A follow-up survey of referring hospitals was conducted.
  
  
  RESULTS
  Short-distance transports enjoyed excellent compliance with 41 of 42 patients being transported by mobile ICU. Long-distance transports by mobile ICU increased from 55% to 65% during the study period. However, a third of the mobile ICU patients actually met air transport criteria. Long-distance patients transported by air had significantly higher transport costs, total hospital charges, and direct admission to the catheterization lab. Five of the 10 surveyed emergency department directors found the triage instrument useful in making transport decisions.
  
  
  CONCLUSIONS
  A physician-developed triage instrument to select an appropriate mode of transport for acute cardiac transfers was effectively used. Further studies must validate the cardiac triage criteria against clinical outcomes, and more effective dissemination of the triage instrument must be sought. Furthermore, this information must be perceived as useful by referring physicians to gain wider acceptance.
authors.affiliation: MedFlight, Columbus, Ohio, USA. hwerman@medflight.com
authors.forename: Howard A
authors.initials: HA
authors.lastname: Werman
authors.forename: Cathy
authors.initials: C
authors.lastname: Jaynes
authors.forename: Gina
authors.initials: G
authors.lastname: Blevins
mesh_terms: D003657:Decision Making; D006302:Health Services Research; D006323:Heart Arrest; D006801:Humans; D014187:Transportation of Patients / Q000379:methods*; D014218:Triage / Q000379:methods*; D014481:United States