Hamilton Schwartz, MD, MEd
Cincinnati Children's Hospital Medical Center
BACKGROUND AND OBJECTIVES: The field of neonatal and pediatric interfacility transport currently has no established evidence-based or consensus-based educational priorities. There are no standardized curricula for organizations to employ in training the health care providers who perform this type of medicine. This deficiency may stem from the lack of industry-approved measures of quality and safety of care. Accurate assessment of quality and patient outcomes requires the use of a standard language permitting comparisons amongst transport programs. The aim of this project was to achieve consensus on appropriate neonatal and pediatric transport quality metrics that in turn may inform best practices and the educational priorities of transport team training programs.
METHODS: Nineteen transport leaders representing six statewide neonatal/pediatric specialty programs convened for a two-day conference. Candidate quality metrics were identified through literature review and those metrics currently tracked by each program. Consensus was governed by nominal group technique. Metrics were categorized in two dimensions: Institute of Medicine (IOM) quality domains and Donabedian’s structure/process/outcome framework.
RESULTS: Two hundred fifty-seven performance metrics relevant to neonatal/pediatric transport were identified. Eliminating duplicate and overlapping metrics resulted in 70 candidate metrics. Nominal group methodology yielded 23 final quality metrics, the largest portion representing Donabedian’s outcome category (n=12, 52%) and the IOM quality domains of effectiveness (n=7, 30%) and safety (n=9, 39%). Sample final metrics include measurement of family presence, pain management, intubation success, neonatal temperature control, use of lights & sirens and medication errors. Lastly, a definition for each metric was established and agreed upon for consistency amongst institutions.
CONCLUSIONS: This study demonstrates quality metrics can be achieved through consensus building and provides the foundation for benchmarking amongst neonatal/pediatric transport programs, quality improvement projects and establishing key training curricula priorities.
