Effect of transport team interventions on stabilization time in neonatal and pediatric interfacility transports

Abstract

During interfacility transport, the length of time taken by the transport team to prepare the patient for transport is often perceived as a problem by referring hospital staff. The purpose of this study was to examine the effects on time at the referring hospital of the number and complexity of interventions performed by the transport team to stabilize the patient prior to transfer. Interfacility transfers by the provincial infant transport team (ITT) to British Columbia's Children's Hospital. This was a prospective study of emergency neonatal and pediatric interfacility transfers. After each transport, the team completed a questionnaire about interventions performed and stabilization time. Transports were classified by the complexity of interventions performed: none, low (intravenous line, blood gas, nasogastric tube, Foley catheter, oxygen administration), or high (intubation, central venous access, arterial lines, chest tube insertion). Thirty of 55 transports required no intervention (mean stabilization time=52+/-25 min). Sixteen transports required low level intervention (mean=60+/-22 min). Nine transports required high level intervention (mean=140+/-52 min). The stabilization times for "no" and "low" levels of intervention were not significantly different (P=.3), but the time for "high" level intervention was significantly higher (P<.01). The need for the transport team paramedics to perform high level interventions significantly increased the time at the referring hospital. In contrast, the time taken for them to perform or reperform low level interventions, whether one procedure or two, was not a significant source of delay.