1668: Design, Development, and Implementation of a Dedicated Pediatric Critical Care Transport Team

Introduction: Timely and safe inter-facility transport of critically ill patients improves outcomes. Our institution prior to 2023 lacked a pediatric critical care ground transport team. To address this, a quality improvement (Q.I) project was initiated to design and develop a pediatric critical care transport team with the specific aim of decreasing dispatch time to < 30 minutes and call-to-hand off time to < 240 minutes, decreasing escalation of care of transported patients, and reducing patient safety events. The hospital’s net operating margin was used as a balancing measure. Methods: A multistage Q.I project was initiated in April 2022, with the goal of launching the ground transport team on 08/01/2023 and prospective data monitoring from 01/01/2024 to 04/15/2025. Q.I methods included team design (per Illinois Tier 3 transport regulations), development of care protocols, standardization of transport documentation, and tracking of key performance metrics (KPM) related to safety, efficacy, and patient outcomes. Transport time was tracked using an X-bar chart, and the proportion of patients meeting target metrics was tracked using a P chart. Patient severity of illness during transport was assessed using Transport Risk Assessment in Pediatrics (TRAP) scores. Results: A total of 471 patients were transported during the project over 16 months, with a median age of 5 years (range 0.01 to 17 years), of whom 210 (44.5%) were admitted to the pediatric ICU. Only 6 patients required escalation of care after arrival; no serious safety events were noted. The median dispatch time was 28 minutes (IQR 22–43), with 54% of dispatches within goal, while the median total time was 211 minutes (IQR 165–264), with 60% meeting the goal time. Overall, the process was stable with no special cause variations identified during the 16-month period. Patients TRAP scores showed a significant decrease during transport, with a mean difference of -0.46 (95% CI -0.31 to -0.60, p< 0.001). The hospital’s direct contribution margin for transported patients was positive, with a mean margin of $6540 (95% CI $4668 to $8413). Conclusions: Transport of critically ill children by a dedicated ground transport team can lead to improvements in patient safety and triage, with a net positive operating revenue.