Effect of patient- and team-related factors on stabilization time during pediatric intensive care transport.

OBJECTIVES

To examine the effects of patient- and transport-related factors on the time spent at the referring hospital by an intensive care retrieval team to stabilize critically ill children and to study the relationship between stabilization time and patient outcome.

DESIGN

: Analysis of prospectively collected data during pediatric intensive care transport.

SETTING

A dedicated regional pediatric intensive care retrieval service performing interhospital transports in England.

PATIENTS

Critically ill children transported to intensive care units over a 2-yr period between April 1, 2006 and March 31, 2008.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Factors related to the patient (age group, diagnostic category, and severity of illness) and transport (time of referral, team response time, and number of major and minor interventions performed) were analyzed for their effect on stabilization time in univariate and multivariate analyses. The relationship between stabilization time and patient outcome in the first 24 hrs post intensive care unit admission was also studied. Patient acuity was high in the transported population (84% invasively ventilated; 28% on vasoactive agents). Predicted mortality risk (Pediatric Index of Mortality 2 score), diagnostic category, team response time, and number of major interventions performed had an independent effect on stabilization time, whereas the length of stabilization itself did not influence early mortality on the intensive care unit. Each minor intervention prolonged the stabilization time by an average of 10 mins.

CONCLUSIONS

Stabilization time during intensive care transport is influenced by a number of patient- and transport-related factors, and cannot be used in isolation as an indicator of team efficiency. Time spent undertaking intensive care interventions early in the course of patient illness at the referring hospital does not worsen patient outcome, suggesting that the "scoop and run" model can be safely abandoned in interhospital transport.