Plug and Play: Mechanical Ventilation Utilization During Critical Care Transport of Patients with Advanced Airway

Abstract

Introduction Healthcare has undergone significant regionalization over the past 20 years, necessitating high quality interhospital transport. Multiple studies have shown that the use of transport mechanical ventilators (MV) in lieu of manual ventilation during such transports provides more consistent ventilation and thus improved clinical outcomes. By analyzing MV use during interhospital transport of patients with advanced airways among diverse neonatal/pediatric/adult transport teams, we sought to describe current practice, identify quality benchmarks, and describe associated performance in relation to other quality indicators. Methods Data are contained in the Ground and Air Medical qUality Transport (GAMUT) database. Use of MV during transport is defined and calculated as follows: NUMERATOR = Number of transport patient contacts during the calendar month involving patient with an advanced airway supported by a MV. DENOMINATOR = Number of transport patient contacts during calendar month involving a patient with an advanced airway. GAMUT data are reported in aggregate monthly using the REDCap database and quality metrics data from December 2016 - December 2017 (12 months) were analyzed. Analyses included stratifying institutions by patient population, evaluation of mean and achievable benchmarks, and rank correlation to identify associations with other GAMUT quality metrics. Results 172 programs supplied GAMUT data on transports during the study period representing 217,434 patient contacts. Of those, 39,185 (18.0%) were transported with an advanced airway and 36,487 (93.1%) of advanced airway patients were supported by a MV. During the same study period, the achievable benchmark of care for MV utilization was 99.6%. Patients transported by pediatric programs were less likely have an advanced airway (12.1%) but also used MV significantly less (88.9%, p Conclusion Amongst GAMUT quality improvement collaborative participants, pediatric programs transported patients with advanced airways less commonly and used MV in those advanced airway patients less frequently. Neonatal programs used MV most frequently. This anlysis provides clarity regarding the use of MV in transport and permits targeted interventions for improved performance and ultimately best practice in this important quality measure.