Vickren Pillay, MD
Medical College of Wisconsin
Brookfield, Wisconsin
Disclosure information not submitted.
Rainer Gedeit, MD
physician
Children's Hospital of Wisconsin, United States
Disclosure information not submitted.
Prakadeshwari Rajapreyar, MD
physician
Medical College of Wisconsin, United States
Disclosure information not submitted.
Title: Variation in Risk Assessment & Management During Intrahospital Transport of Critically Ill Children
Introduction: Critically ill children often require intrahospital transport (IHT) for diagnostic and/or therapeutic procedures. Previous literature describes the increased risks of adverse events during IHT of critically ill patients. These events include physiologic deterioration, medication errors and equipment failure. There are no published standards to guide risk assessment and safe transport during IHT. The purpose of this study was to identify commonalities and differences between institutions in performing IHT.
Methods: This study was performed using a survey distributed through the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) member email. Participation in the survey was voluntary. The survey had two arms, one for clinicians whose institutions have a standard process for IHT and for those who do not. All participants answered demographic questions, clinical scenarios, and common IHT questions. Common IHT questions were developed based on prior research outlining the risks associated with IHT.
Results: A total of 110 surveys were included in the analysis. Most respondents were Pediatric Intensive Care Unit attending physicians (82%). Thirty three percent (33%) of respondents noted that their institutions used a standard process for IHT. The standard processes defined personnel in 86%, medications taken in 78%, equipment used 89%, performance of a timeout 53%, debriefing in 19% and documentation in 53%. For those not using a standard process 75 % noted collaboration between team members (bedside nurse, attending physician, respiratory care practitioner) to determine medication, personnel and equipment used during IHT. Common factors used by all respondents to determine IHT risk included: patient instability (85%) use of inotropes/pressors (83%); presence of an endotracheal tube (80%); or stability of an artificial airway (83%). Less common factors included: presence of arterial line (45%): central venous pressure monitoring (23%): or intracranial pressure monitoring (66%).
Conclusion: For IHT there are few institutions where a standard process is used. The standard processes have some variability in what they define. Most providers use common factors to assess risk during IHT. The common ground may allow for the development of a standardized practice to assess and reduce risk during IHT.