title: Effect of Transition From a Unit-Based Team to External Transport Team for a Pediatric Critical Care Unit.
abstract: OBJECTIVE
  Pediatric hospitals must consider staff, training, and direct costs required to maintain a pediatric specialized transport team, balanced with indirect potential benefits of marketing and referral volume. The effect of transitioning a unit-based transport team to an external service on the pediatric intensive care unit (PICU) is unknown, but information is needed as hospital systems focus on population management. We examined the impact on PICU transports after transition to an external transport vendor.
  
  
  METHODS
  Single-center retrospective review performed of PICU admissions, referrals, and transfers during baseline, post-, and maintenance period with a total of 9-year follow-up. Transfer volume was analyzed during pre-, post-, and maintenance phase with descriptive statistics and statistical process control charts from 1999 to 2012.
  
  
  RESULTS
  Total PICU admissions increased with an annual growth rate of 3.7%, with mean annual 626 admissions prior to implementation to the mean of 890 admissions at the end of period, P < .001. The proportion of transport to total admissions decreased from 27% to 21%, but mean annual transports were unchanged, 175 to 183, P = .6, and mean referrals were similar, 186 to 203, P = .8. Seasonal changes in transport volume remained as a predominant source of variability. Annual transport refusals increased initially in the postimplementation phase, mean 11 versus 33, P < .03, but similar to baseline in the maintenance phase, mean 20/year, P = .07. Patient refusals were due to bed and staffing constraints, with 7% due to the lack of transport vendor availability.
  
  
  CONCLUSIONS
  In a transition to a regional transport service, PICU transport volume was maintained in the long-term follow-up and total PICU admissions increased. Further research on the direct and indirect impact of transport regionalization is needed to determine the optimal cost-benefit and quality of care as health-care systems focus on population management.
authors: 1 Department of Pediatrics, Pediatric Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors: Brian M
authors: BM
authors: Cummings
authors: 1 Department of Pediatrics, Pediatric Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors: Kanakaraju
authors: K
authors: Kaliannan
authors: 1 Department of Pediatrics, Pediatric Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors: Phoebe H
authors: PH
authors: Yager
authors: 1 Department of Pediatrics, Pediatric Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA.
authors: Natan
authors: N
authors: Noviski
mesh_terms: D002648:Child; D003422:Critical Care / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006284:Health Plan Implementation / Q000706:statistics & numerical data; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D008297:Male; D020416:Outsourced Services / Q000379:methods / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000379:methods / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012041:Regional Medical Programs / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014187:Transportation of Patients
keywords: ICU organization; administration; pediatric intensive care; transport