Transportation of critically ill patient to Pediatric Intensive Care Unit, Siriraj Hospital

Abstract

This retrospective study was undertaken to evaluate and identify some difficulties encountered in the process of interhospital transport of pediatric critically ill patients from remote hospitals to the Pediatric Intensive care unit (PICU) of the Department of Pediatrics, Faculty of Medicine Siriraj Hospital. The study was conducted between 1st June, 2001 and 30th June, 2003. Total number of patients transferred to PICU were 36. Most patients suffered from respiratory diseases (14 cases, 38.9%) and cardiovascular diseases (8 cases, 22.2%) prior to transfer. Five patients (13.9%) had cardiac arrest and required CPR prior to the transfers. Twelve cases (30%) were transferred at the parents' request or and due to socioeconomic problems. All patients were transported by ambulance. The longest transfer duration was from a hospital in Chiangmai province (11 hours by road transfer). The majority of accompanying medical personnel were nurses (55.5%) with no experience in intensive care pediatrics. In no cases were any doctors or trained paramedics presented with the transport team. Prior to transportation, the PICU physician was phone-contacted by the referring physician. The patients' status prior to being transferred to PICU were as follows; 23 cases (63.9%) were intubated, 4 (11.1%) cases had intravenous cut down and 10 (27.8%) were infused inotropic drug. None of the patients had any record on important patient's data (e.g. vital signs, oxygen saturation) or adverse events during transport such as equipment problems and clinical deteriorations. Twenty eight patients (77.8%) stayed in PICU average length of less than 7 days. Eleven patients died (mortality rate of 30.59%). In conclusion, the major obstacle in properly transporting patients to the PICU was the lack of experience/knowledge of transport team to perform safe transfer in pediatrics during transport. The second problem was lack of documentation or record of vital signs and adverse events observed during the transfer. Organization of effective team working in pediatric transfer to PICU is inevitably needed to improve the outcome of these critically ill patients.