Should parents accompany critically ill children during inter-hospital transport?

Abstract

Background: Parental accompaniment during inter-hospital transportation (retrieval) of critically ill children is not commonplace in the United Kingdom.

Methods: A three month pilot of parental accompaniment was undertaken in 2002 (143 retrievals), after which time the policy was adopted as standard practice. A follow up audit was performed in 2004 (136 retrievals).

Results: Findings were remarkably consistent between the two periods. Staff perceived little or no added stress during the majority of transfers (96% in 2002, 98% in 2004), and felt able to perform medical interventions without hindrance (98% in 2002, 100% in 2004). There was good agreement between medical and nursing staff regarding perception of stress and ability to perform interventions (phi statistic 0.57 to 1.00). Adverse events occurred during 11 (3.9%) retrievals; six of these involved a parent exclusively. Stress tended to be associated with adverse events or parental behaviour rather than disease acuity. Staff vetoed the offer of accompaniment on 11 occasions, for a variety of reasons. The majority of parents found the experience safe, beneficial, and perceived a reduction in stress as a result. These data may inform other retrieval services who are considering adopting a similar policy.

Figure 1

Agreement between medical and nursing staff according to the perception of stress and the ability to intervene while in the ambulance. Phi (Φ) was calculated by converting the above 5x5 tables to 2x2 tables, with scores of 1–2 indicating the absence of stress/difficulty, and scores of 3–5 indicating presence of stress/difficulty. Φ = [(odds ratio agreement)^0.5–1]/[(odds ratio agreement)^0.5+1].