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Goh S, Siu JM, Philteos J, James AL, Ostrow O, McKinnon NK, Everett T, Levine M, Whyte H, Lam CZ, Propst EJ, Wolter NE. Pediatric Esophageal Button Battery Protocol Reduces Time From Presentation to Removal. Laryngoscope 2024. [PMID: 38934450 DOI: 10.1002/lary.31607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 06/12/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE Evaluate implementation of an institutional protocol to reduce the time to removal of esophageal button battery (BB) and increase use of mitigation strategies. METHODS We developed a protocol for esophageal BB management [Zakai's Protocol (ZP)]. All cases of esophageal BB impaction managed at a tertiary care center before and after implementation from 2011 to 2023 were reviewed. Time to BB removal, adherence to critical steps, and use of mitigation strategies (honey/sucralfate, acetic acid) were evaluated. RESULTS Fifty-one patients (38 pre-ZP, 13 post-ZP) were included. Median age was 2.3 years (IQR 1.3-3.4). After implementation, the time from arrival at the institution to arrival in the operating room (OR) reduced by 4.2 h [4.6 h (IQR 3.9-6.5) to 0.4 h (IQR 0.3-0.6), p < 0.001] and there was improvement in all management steps. The number of referrals direct to otolaryngology increased from 51% to 92%, arrival notification increased from 86% to 100%, avoidance of second x-ray increased from 63% to 100%, and direct transfer to OR increased from 92% to 100%. Adherence to mitigation strategies such as preoperative administration of honey or sucralfate increased from 0% to 38%, intraoperative use of acetic acid from 3% to 77%, and nasogastric tube insertion from 53% to 92%. CONCLUSION Implementation of ZP substantially reduced the time to BB removal and the use of mitigation strategies in our tertiary care institution. Additional strategies focused on prevention of BB ingestion, and shortening the transfer time to the tertiary care hospital are required to prevent erosive complications. LEVEL OF EVIDENCE Level 3 Case-series Laryngoscope, 2024.
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Affiliation(s)
- Samantha Goh
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer M Siu
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Justine Philteos
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Adrian L James
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Olivia Ostrow
- Division of Pediatric Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children University of Toronto, Toronto, Ontario, Canada
| | - Nicole K McKinnon
- Department of Critical Care Medicine, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Tobias Everett
- Department of Anesthesiology and Pain Medicine, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Mark Levine
- Department of Anesthesiology and Pain Medicine, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Hilary Whyte
- Department of Pediatrics-Division of Neonatology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Christopher Z Lam
- Department of Diagnostic Imaging, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Evan J Propst
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nikolaus E Wolter
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Mwizerwa O, Umuhoza C, Corden MH, Lissauer T, Cartledge PT. Closing the communication gap in neonatal inter-hospital transfer: a neonatal referral form for resource-limited settings - a modified e-Delphi-consensus study. F1000Res 2022; 10:365. [PMID: 35814632 PMCID: PMC9201411 DOI: 10.12688/f1000research.50980.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 11/28/2022] Open
Abstract
Background: Standardised neonatal referral forms (NRFs) facilitate effective communication between healthcare providers and ensure continuity of care between facilities, which are essential for patient safety. We sought to determine the essential data items, or core clinical information (CCI), that should be conveyed for neonatal inter-hospital transfer in resource-limited settings (Rounds 1 to 3) and to create an NRF suitable for our setting (Round 4). Methods: We conducted an international, four-round, modified Delphi-consensus study. Round-1 was a literature and internet search to identify existing NRFs. In Round-2 and -3, participants were Rwandan clinicians and international paediatric healthcare practitioners who had worked in Rwanda in the five years before the study. These participants evaluated the draft items and proposed additional items to be included in an NRF. Round-4 focused on creating the NRF and used five focus groups of Rwandan general practitioners at district hospitals. Results: We identified 16 pre-existing NRFs containing 125 individual items. Of these, 91 items met the pre-defined consensus criteria for inclusion in Round-2. Only 33 items were present in more than 50% of the 16 NRFs, confirming the need for this consensus study. In Round-2, participants proposed 12 new items, six of which met the pre-defined consensus criteria. In Round-3, participants scored items for importance, and 57 items met the final consensus criteria. In Round-4, 29 general practitioners took part in five focus groups; a total of 16 modifications were utilised to finalise the NRF. Conclusions: We generated a novel, robust, NRF that may be readily employed in resource-limited settings to communicate the essential clinical information to accompany a neonate requiring inter-hospital transfer.
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Affiliation(s)
- Oscar Mwizerwa
- Department of Pediatrics and Child Health, University of Rwanda, Kigali, Rwanda
- Department of Pediatrics, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Christian Umuhoza
- Department of Pediatrics and Child Health, University of Rwanda, Kigali, Rwanda
- Department of Pediatrics, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Mark H. Corden
- Rwanda Human Resources for Health (HRH) Programme, Ministry of Health, Kigali, Rwanda
- Division of Hospital Medicine, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, California, USA
| | - Tom Lissauer
- Department of Neonatology, Imperial College Healthcare Trust, London, UK
- Royal College of Paediatrics and Child Health (RCPCH UK), Kigali, Rwanda
| | - Peter Thomas Cartledge
- Department of Pediatrics, University Teaching Hospital of Kigali, Kigali, Rwanda
- Rwanda Human Resources for Health (HRH) Programme, Ministry of Health, Kigali, Rwanda
- Department of Pediatrics, Yale University, New Haven, Connecticut, USA
- Centre for Paediatrics and Child Health, Imperial College London, London, UK
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Ali A, Miller MR, Cameron S, Gunz AC. Pediatric Transport Safety Collaborative: Adverse Events With Parental Presence During Pediatric Critical Care Transport. Pediatr Emerg Care 2022; 38:207-212. [PMID: 34693934 DOI: 10.1097/pec.0000000000002561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In Canada, critically ill pediatric patients require transfer to a tertiary care center for definitive medical and surgical management. Some studies suggest that family accompaniment could compromise care; currently, limited research has examined patient safety and outcomes during pediatric critical care transport with family presence, and no Canada-specific data currently exists. The primary objective of this study was to compare the rate of adverse events during the transport of pediatric patients by a specialized pediatric critical care transport team with parental accompaniment to those without parental accompaniment. Secondary objectives included whether geographic or patient-specific factors affected rates of parental accompaniment and if parental presence during transport was related to patient outcomes. METHODS Retrospective cohort study in a pediatric critical care unit convenience sample at an academic children's hospital. Inclusion criteria constituted all patients younger than 18 years who were admitted to the pediatric critical care unit after interfacility transport by the London Health Sciences Center Neonatal Pediatric Transport Team between April 1, 2018, and April 30, 2020, inclusive. Adverse event rates, patient characteristics, and clinical outcomes were compared. RESULTS There were 357 transports eligible for analysis. Of these, there were 180 transports with, and 177 without, parental accompaniment. The primary outcome was adverse event occurrence using the composite definition of adverse events, previously defined by a Canadian consensus process, which included patient-, transport provider-, laboratory-, and system/vehicle-related safety factors. The occurrence of adverse events was not significantly different between transports with and without parental accompaniment, 49.4% and 54.8%, respectively (odds ratio, 0.80; P = 0.311). CONCLUSIONS This is the first study to compare the effect on adverse event rate and clinically relevant outcomes between transports with and without parental presence during interfacility pediatric critical care transport. Our study found no significant difference in the adverse event rate between transports with and without parental presence.
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Affiliation(s)
- Aaisham Ali
- From the Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University
| | | | - Saoirse Cameron
- From the Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University
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Yock-Corrales A, Casson N, Sosa-Soto G, Orellana RA. Pediatric Critical Care Transport: Survey of Current State in Latin America. Latin American Society of Pediatric Intensive Care Transport Committee. Pediatr Emerg Care 2022; 38:e295-e299. [PMID: 33105465 DOI: 10.1097/pec.0000000000002273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
METHODS An electronic, anonymous, multicenter survey housed by Monkey Survey was sent to physicians in LA and included questions about hospital and pediatric critical transport, resources available and level of car. Nineteen Latin-American countries were asked to complete the survey. RESULTS A total of 212 surveys were analyzed, achieving a representativity of 19 LA countries, being most participants (59.4%, n = 126) from South America (Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Paraguay, Peru, Uruguay and Venezuela). Most surveys were conducted by physicians of tertiary level centers (60.8%, n = 129), most of the institutions were classified by the participants as public health care centers (81.6%, n = 173). Most of the surveyed physicians (63.7%, n = 135) reported that there is a coordination center for critical care transport (CCT). In most cases, physicians report that a unified transport system for pediatric critical patients does not exist in their countries (67.45%, n = 143). Only 59 (30.7%) surveys reported the use of an exclusively pediatric critical care transport system. Most of these transport systems are described as a mixture of public and private efforts (51.56%, n = 99), but there is also a considerable involvement of government-funded critical transport systems (43.75%, n = 84). Specific training for personnel devoted to transportation of critically ill patients is reported in 55.6% (90), and the medical equipment necessary to carry out the transport is available in 67.7%. The majority (83.95%, n = 136) mentioned that access to advanced life support courses is possible. Training in triage and disaster is available in 44.1%. Physicians and registered nurse were identified as the transport providers in 41.5%, and only one third were made by pediatricians-pediatric nurse. The main reasons for transfers were respiratory illness, neonatal pathologies, trauma, infectious diseases, and neurological conditions. Overall, pediatric transport was reported as insufficient (70.19%, n = 148) by the surveyed physicians in LA and nonexisting by some of them (6.83%, n = 15). There were no regulations or laws in the majority of the surveyed countries (63.13%), and in the places where physicians reported regulatory laws, there were no dissemination (84.9%) by the local authorities. CONCLUSIONS In LA, there is a great variability in personnel training, equipment for pediatric-neonatal transport, transport team composition, and characterization of critical care transport systems. Continued efforts to improve conditions in our countries by generating documents that standardize practices and generating scientific information on the epidemiology of pediatric transfers, especially of critically ill patients, may help reduce patient morbidity and mortality.
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Affiliation(s)
- Adriana Yock-Corrales
- From the Pediatric Emergency Department, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", CCSS, San José, Costa Rica
| | - Nils Casson
- Pediatric Critical Care Unit, Hospital Regional San Juan de Dios, Tarija, Bolivia
| | | | - Renan A Orellana
- Pediatric Critical Care Unit, Texas Children's Hospital, Houston, TX
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Marsinyach Ros I, Sanchez García L, Sanchez Torres A, Mosqueda Peña R, Pérez Grande MDC, Rodríguez Castaño MJ, Elorza Fernández MD, Sánchez Luna M. Evaluation of specific quality metrics to assess the performance of a specialised newborn transport programme. Eur J Pediatr 2020; 179:919-928. [PMID: 31993775 PMCID: PMC7223594 DOI: 10.1007/s00431-020-03573-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 12/20/2019] [Accepted: 01/10/2020] [Indexed: 12/02/2022]
Abstract
There is a lack of consensus on quality indicators suitable for neonatal transport. The aim of this study is to make a proposal for specific quality indicators for newborn transport. A retrospective descriptive study was performed (2009 to 2015) where twenty-four indicators were selected, evaluated and classified according to the 6 dimensions of quality of the Institute of Medicine. Among the 24 evaluated quality metrics, there were 3 of them which needed a correction when evaluating neonatal transport performance, because they were significantly correlated with gestational age. They were (a) stabilisation time, (b) prevalence of newborn arterial hypotension (defined by gestational age) and (c) unnoticed hypothermia at referral hospital.Conclusion: Quality evaluation through the definition of specific metrics in newborn transport is feasible. These indicators should be defined or adjusted for newborn population to measure the actual performance of the transport service.What is Known:• Quality indicators may help in defining metrics for clinical practice, promoting benchmarking and defining areas of improvement.• Newborn characteristics call for a specialised care, and quality measure during newborn transport require specific metrics. Quality metrics for paediatric transport have been defined using Delphi method. Some of these measures need to be specific for newborn, due to their intrinsic characteristics.What is New:• Using evidence-based literature and our newborn transport experience, specific quality indicators for newborn transport are suggested.• Data analysis shows how some indicators need to be adjusted for gestational age.
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Affiliation(s)
- Itziar Marsinyach Ros
- Newborn Specialized Transport Madrid (SUMMA 112), Neonatology Department, Gregorio Marañón Hospital, O’Donnell 48 Street, 28009 Madrid, Spain
| | - Laura Sanchez García
- Newborn Specialized Transport Madrid (SUMMA 112), Neonatology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Ana Sanchez Torres
- Newborn Specialized Transport Madrid (SUMMA 112), Neonatology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Rocio Mosqueda Peña
- Newborn Specialized Transport Madrid (SUMMA 112), Neonatology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Maria del Carmen Pérez Grande
- Newborn Specialized Transport Madrid (SUMMA 112), Neonatology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Maria José Rodríguez Castaño
- Newborn Specialized Transport Madrid (SUMMA 112), Neonatology Department, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Manuel Sánchez Luna
- Newborn Specialized Transport Madrid (SUMMA 112), Neonatology Department, Gregorio Marañón Hospital, O’Donnell 48 Street, 28009 Madrid, Spain
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Abstract
OBJECTIVES We developed a Pediatric Transport Triage Tool (PT3) to objectively guide selection of team composition and transport mode, thereby standardizing transport planning. Previously, modified Pediatric Early Warning Score for transport has been used to assess illness severity but not to guide transport decision making. METHODS The PT3 was created for pediatric transport by combining objective evaluations of neurologic, cardiovascular, and respiratory systems with a systems-based medical condition list to identify diagnoses requiring expedited transport and/or advanced team composition not captured by neurologic, cardiovascular, and respiratory systems alone. A scoring algorithm was developed to guide transport planning. Transport data (mode, team composition, time to dispatch, patient disposition, and complications) were collected before and after PT3 implementation at a single tertiary care center over an 18-month period. RESULTS We reviewed 2237 inbound pediatric transports. Transport mode, patient disposition, and dispatch time were unchanged over the study period. Fewer calls using a transport nurse were noted after PT3 implementation (33.9% vs 30%, P = 0.05), with a trend toward fewer rotor-wing transports and transports requiring physicians. The majority of users, regardless of experience level, reported improved transport standardization with the tool. Need to upgrade team composition or mode during transport was not different during the study period. No adverse patient safety events occurred with PT3 use. CONCLUSIONS The PT3 represents an objective triage tool to reduce variability in transport planning. The PT3 decreased resource utilization and was not associated with adverse outcomes. Teams with dynamic staffing models, various experience levels, and multiple transport modes may benefit from this standardized assessment tool.
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Abstract
OBJECTIVES This study aimed to better understand the unique aspects of pediatric critical care transport programs across Canada by characterizing the current workforce of each transport program. METHODS A cross-sectional questionnaire was sent to the 13 medical directors of Canada's pediatric critical care transport teams, and to 2 nonhospital-affiliated transport services. If a children's hospital did not have a dedicated team for pediatric transport, the regional transport team providing this service was identified. RESULTS Eight of the 13 pediatric intensive care units surveyed have unit-based pediatric transport teams. The median annual transport volume for the 8 hospital-based teams was 371 (range, 45-2300) with a total of 5686 patients being transported annually. Among patients transported by the 8 teams, 45% (2579 patients) were pediatric patients (older than 28 days and younger than 18 years) and 40% (1022 patients) of the pediatric patients were admitted to the pediatric intensive care units. Eighty-eight percent of the responding teams also transported neonates (older than 28 days), and 38% transported premature infants.A team composition of registered nurse-respiratory therapist-physician was used by 6/13 teams (75%); however, it accounted for only a small proportion of the transports for most of the teams (median, 2%; range, 2%-100%).The average transport time from dispatch (from team home site) to arrival at receiving facility was reported by 6 teams, and has a median of 195 minutes (range, 90-360 minutes). The median distance from home site to the farthest referral site in the catchment area was 700 km (range, 15-2500 km). CONCLUSIONS This is the first Canadian nationwide study of pediatric critical care transport programs. It revealed a complexity and variability in transport team demographics, transport volume, team composition, and decision-making process.
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Colyer E, Sorensen M, Wiggins S, Struwe L. The Effect of Team Configuration on the Incidence of Adverse Events in Pediatric Critical Care Transport. Air Med J 2018; 37:186-198. [PMID: 29735232 DOI: 10.1016/j.amj.2018.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 02/20/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Specialty pediatric transport teams are widely used for pediatric interfacility transport in the United States, with little industry consensus on optimal team configuration. The aim of this study is to assess the quality of the nurse/paramedic specialty team configuration as indirectly measured by the rate of adverse events in these transports. METHODS Retrospective analysis of pediatric transport data from a hospital-based dedicated pediatric/neonatal transport team was conducted for patients transported in 2016. Data were categorized by general characteristics of transport and analyzed for the occurrence of adverse events. RESULTS Five hundred sixty-four cases were analyzed. Cases were described by team configuration and then by transport mode, duration, time, patient age and acuity, and disposition. The overall rate of adverse event incidence was 8.3%, chiefly centered in device and process domains. There was no significant difference in the rate of adverse events between team configurations. CONCLUSION There was no significant difference in the rate of adverse event occurrence in nurse/paramedic team configurations versus nurse/nurse configuration. Using critical care paramedics on pediatric transport teams enables a larger volume of patients to be transported to definitive care without concerns for decrease in quality or safety.
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Affiliation(s)
- Emily Colyer
- Pediatric/Neonatal Critical Care Transport Team, Children's Hospital & Medical Center, Omaha, NE.
| | - Megan Sorensen
- Pediatric/Neonatal Critical Care Transport Team, Children's Hospital & Medical Center, Omaha, NE
| | - Shirley Wiggins
- College of Nursing, University of Nebraska Medical Center, Lincoln, NE
| | - Leeza Struwe
- College of Nursing, University of Nebraska Medical Center, Lincoln, NE; Niedfelt Nursing Research Center, University of Nebraska Medical Center, Lincoln, NE
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Kawaguchi A, Nielsen CC, Saunders LD, Yasui Y, de Caen A. Impact of physician-less pediatric critical care transport: Making a decision on team composition. J Crit Care 2018; 45:209-214. [PMID: 29579572 DOI: 10.1016/j.jcrc.2018.03.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/13/2018] [Accepted: 03/18/2018] [Indexed: 01/04/2023]
Abstract
PURPOSE To explore the impact of a physician non-accompanying pediatric critical care transport program, and to identify factors associated with the selection of specific transport team compositions. MATERIALS AND METHODS Children transported to a Canadian academic children's hospital were included. Two eras (Physician-accompanying Transport (PT)-era: 2000-07 when physicians commonly accompanied the transport team; and Physician-Less Transport (PLT)-era: 2010-15 when a physician non-accompanying team was increasingly used) were compared with respect to transport and PICU outcomes. Transport and patient characteristics for the PLT-era cohort were examined to identify factors associated with the selection of a physician accompanying team, with multivariable logistic regression with triage physicians as random effects. RESULTS In the PLT-era (N=1177), compared to the PT-era (N=1490) the probability of PICU admission was significantly lower, and patient outcomes including mortality were not significantly different. Associations were noted between the selection of a physician non-accompanying team and specific transport characteristics. There was appreciable variability among the triage physicians for the selection of a physician non-accompanying team. CONCLUSIONS No significant differences were observed with increasing use of a physician non-accompanying team. Selection of transport team compositions was influenced by clinical and system factors, but appreciable variation still remained among triage physicians.
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Affiliation(s)
- Atsushi Kawaguchi
- Department of Pediatrics, Pediatric Critical Care Medicine, University of Alberta, Canada; School of Public Health, University of Alberta, Canada.
| | - Charlene C Nielsen
- Department of Pediatrics, University of Alberta, Canada; Faculty of Science, Department of Earth and Atmospheric Sciences, Canada
| | | | - Yutaka Yasui
- School of Public Health, University of Alberta, Canada
| | - Allan de Caen
- Department of Pediatrics, Pediatric Critical Care Medicine, University of Alberta, Canada
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Duran SR, Aggarwal S, Natarajan G. The effect of transport on the physiologic stability of neonates with ductal-dependent single-ventricle lesions. J Matern Fetal Neonatal Med 2018; 31:500-505. [DOI: 10.1080/14767058.2017.1289164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Silvestre R. Duran
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI, USA
| | - Sanjeev Aggarwal
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI, USA
| | - Girija Natarajan
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI, USA
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Krmpotic K, Van den Bruel A, Lobos AT. A Modified Delphi Study to Identify Factors Associated With Clinical Deterioration in Hospitalized Children. Hosp Pediatr 2017; 6:616-625. [PMID: 27686826 DOI: 10.1542/hpeds.2016-0006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Hospitalized children who are admitted to the inpatient ward can deteriorate and require unplanned transfer to the PICU. Studies designed to validate early warning scoring systems have focused mainly on abnormalities in vital signs in patients admitted to the inpatient ward. The objective of this study was to determine the patient and system factors that experienced clinicians think are associated with progression to critical illness in hospitalized children. METHODS We conducted a modified Delphi study with 3 iterations, administered electronically. The expert panel consisted of 11 physician and nonphysician health care providers from hospitals in Canada and the United States. RESULTS Consensus was reached that 21 of the 57 factors presented are associated with clinical deterioration in hospitalized children. The final list of variables includes patient characteristics, signs and symptoms in the emergency department, emergency department management, and system factors. CONCLUSIONS We generated a list of variables that can be used in future prospective studies to determine if they are predictors of clinical deterioration on the inpatient ward.
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Affiliation(s)
- Kristina Krmpotic
- Department of Pediatrics, Janeway Children's Health and Rehabilitation Centre, St. John's, Canada; Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada;
| | - Ann Van den Bruel
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Anna-Theresa Lobos
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada; and Faculty of Medicine, University of Ottawa, Ottawa, Canada
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Gunz AC, McNally JD, Whyte H, O'Hearn K, Foster JR, Parker MJ, Dhanani S. Defining Significant Events for Neonatal and Pediatric Transport: Results of a Combined Delphi and Consensus Meeting Process. J Pediatr Intensive Care 2016; 6:165-175. [PMID: 31073443 DOI: 10.1055/s-0036-1597658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 04/13/2016] [Indexed: 12/19/2022] Open
Abstract
Objective To develop standardized definitions for a list of indicators that represent significant events during pediatric transport, which were previously identified by a national Delphi study. Methods We designed a three-phase consensus process that applied Delphi methodology to a combination of electronic questionnaires and a live consensus meeting. Results Thirty-one pediatric transport experts evaluated a total of 59 indicators. Twenty-four indicators represented events or interventions that did not require definition. One indicator was removed from the list. Definitions for the remaining 34 indicators were developed. Conclusion This standardized indicator list is intended for application to quality improvement and clinical research initiatives.
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Affiliation(s)
- A C Gunz
- Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - J D McNally
- Division of Critical Care, Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - H Whyte
- Division of Neonatology, Department of Paediatrics, University of Toronto, Hospital for Sick Children, Toronto, Canada
| | - K O'Hearn
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - J R Foster
- Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - M J Parker
- Division of Critical Care, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Division of Emergency Medicine, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Canada
| | - S Dhanani
- Division of Critical Care, Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Canada
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Frequency, Composition, and Predictors of In-Transit Critical Events During Pediatric Critical Care Transport. Pediatr Crit Care Med 2016; 17:984-991. [PMID: 27505717 DOI: 10.1097/pcc.0000000000000919] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Transport of pediatric patients is common due to healthcare regionalization. We set out to determine the frequency of in-transit critical events during pediatric critical care transport and identify factors associated with these events. DESIGN Retrospective cohort study using administrative and clinical data. SETTING Single pediatric critical care transport provider in Ontario, Canada. PATIENTS All pediatric care transports between January 1, 2005, and December 31, 2010. MEASUREMENTS AND MAIN RESULTS The primary outcome was in-transit critical events, defined by an adaptation of a recent consensus definition. In-transit critical events occurred in 1,094 (12.3%) of 8,889 transports. Hypotension (3.6%), tachycardia (3.7%), and bradycardia (3.3%) were the most common critical events. Crews performed medical interventions in 194 transports (2.2%). The frequency and makeup of critical events varied across patient age groups. Age, pretransport mechanical ventilation, pretransport cardiovascular instability, transport duration, scene calls, and paramedic crew level were independently associated with increased risk of in-transit critical events in multivariate analysis. A Transport Pediatric Early Warning Score of 7 or greater predicted in-transit critical events with high specificity but low sensitivity (92.0% and 20.0%, respectively), but was not superior of the combination of pretransport mechanical ventilation and pretransport cardiovascular instability (sensitivity and specificity of 12.6% and 97.4%, respectively). Removal of early warning signs from the definition resulted in critical event rates comparable to those published in adults and improved predictive performance. CONCLUSIONS Using new consensus definitions of transport-related critical events, we found critical events occurred in almost one in eight transports, and were strongly associated with pretransport cardiovascular instability. Transport Pediatric Early Warning Score was poorly predictive of in-transit critical events, and was not superior to the presence of pretransport mechanical ventilation and cardiovascular instability. Future prospective studies are required to elucidate the optimal matching of transport resources to patients, in particular those with both pretransport cardiovascular instability and mechanical ventilation.
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Critical Care Transport: How Perilous the Trip. Pediatr Crit Care Med 2016; 17:1008-1009. [PMID: 27705990 DOI: 10.1097/pcc.0000000000000927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Whyte HEA, Jefferies AL. The interfacility transport of critically ill newborns. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.265] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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