title: Specialty pediatric transport in primary care or urgent care settings.
abstract: OBJECTIVE
  We sought to describe a single center's experience with specialized critical care transport from non-hospital settings, including primary care offices and urgent care centers. We hypothesized that the majority of patients will require procedures outside the scope of practice of most EMS providers and will be better served by specialized pediatric critical care transport (SPCCT) teams.
  
  
  METHODS
  This study sought to retrospectively evaluate instances where children (0-18 years old) were transported by our SPCCT team from nonhospital settings, including primary care offices and urgent care centers, in 2009 and 2010. Data were extracted from a customized database and appropriate statistical tests were applied, including Fisher's exact test for categorical comparisons and Mann-Whitney U test for non-parametric data comparisons.
  
  
  RESULTS
  Fifty-two patients were included. Most of the children were transported for respiratory distress (78%), and many were treated with albuterol (42%) and steroids (42%) prior to the SPCCT team arrival. The most common interventions performed by the SPCCT team were obtaining IV access and administering IV fluid boluses; 4 (7.7%) patients required advanced critical care treatments unique to SPCCT. Most patients (n = 34; 65%) were directly admitted to the general care floor, but a high number of patients (n = 12; 23%; PICU = 11, NICU = 1) required pediatric or neonatal intensive care unit admission. Only 3 patients (5.7%) were discharged home without hospital admission. For the 11 patients admitted to the PICU, the median length of stay (LOS) was 2.5 days (IQR 0.14-13.2). All patients survived to hospital discharge with an additional hospital LOS of 1.3 days (IQR 0.2-6.7). Patients were billed for these critical care transports an average of $2,660.14 ± $940.
  
  
  CONCLUSIONS
  Our small cohort demonstrates infrequent application of advanced critical care interventions beyond those provided by the referring primary care office or urgent care centers. This supports the practice of SPCCT teams providing transport services for select critically ill children at primary care offices and urgent care centers, but not as a standard practice for most pediatric patients in these settings.
authors.affiliation: Akron Children's Hospital, Department of Pediatrics, Akron, OH, USA.
authors.forename: Crystal N
authors.initials: CN
authors.lastname: Joyce
authors.affiliation: Yale University School of Medicine, Department of Pediatrics, Division of Critical Care, New Haven, CT, USA.
authors.forename: John S
authors.initials: JS
authors.lastname: Giuliano
authors.affiliation: Biostats Inc, East Canton, OH, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Gothard
authors.affiliation: Cincinnati Children's Hospital, Department of Pediatrics, Division of Emergency Medicine, Cincinnati, OH, USA.
authors.forename: Hamilton P
authors.initials: HP
authors.lastname: Schwartz
authors.affiliation: Akron Children's Hospital, Department of Pediatrics, Akron, OH, USA. Electronic address: mbigham@chmca.org.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Bigham
mesh_terms: D000293:Adolescent; D000554:Ambulatory Care Facilities; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000379:methods / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010865:Pilot Projects; D011320:Primary Health Care; D017064:Process Assessment, Health Care; D012189:Retrospective Studies; D014187:Transportation of Patients / Q000458:organization & administration*