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J Pediatr Intensive Care 2017; 06(03): 165-175
DOI: 10.1055/s-0036-1597658
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Defining Significant Events for Neonatal and Pediatric Transport: Results of a Combined Delphi and Consensus Meeting Process

A. C. Gunz
1   Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
,
J. D. McNally
2   Division of Critical Care, Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Canada
,
H. Whyte
3   Division of Neonatology, Department of Paediatrics, University of Toronto, Hospital for Sick Children, Toronto, Canada
,
K. O'Hearn
4   Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
,
J. R. Foster
1   Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
5   Department of Pediatrics, Dalhousie University, Halifax, Canada
,
M. J. Parker
6   Division of Critical Care, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
7   Division of Emergency Medicine, Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Canada
,
S. Dhanani
2   Division of Critical Care, Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Canada
› Author Affiliations
Further Information

Publication History

09 November 2016

13 April 2016

Publication Date:
28 December 2016 (online)

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Abstract

Objective To develop standardized definitions for a list of indicators that represent significant events during pediatric transport, which were previously identified by a national Delphi study.

Methods We designed a three-phase consensus process that applied Delphi methodology to a combination of electronic questionnaires and a live consensus meeting.

Results Thirty-one pediatric transport experts evaluated a total of 59 indicators. Twenty-four indicators represented events or interventions that did not require definition. One indicator was removed from the list. Definitions for the remaining 34 indicators were developed.

Conclusion This standardized indicator list is intended for application to quality improvement and clinical research initiatives.

Keywords

transportation of patients - outcome assessment (health care) - intensive care units - pediatrics
 

  • References

  • 1 Britto J, Nadel S, Maconochie I, Levin M, Habibi P. Morbidity and severity of illness during interhospital transfer: impact of a specialised paediatric retrieval team. BMJ 1995; 311 (7009): 836-839
    CrossrefPubMedGoogle Scholar
  • 2 Edge WE, Kanter RK, Weigle CG, Walsh RF. Reduction of morbidity in interhospital transport by specialized pediatric staff. Crit Care Med 1994; 22 (07) 1186-1191
    CrossrefPubMedGoogle Scholar
  • 3 Macnab AJ. Optimal escort for interhospital transport of pediatric emergencies. J Trauma 1991; 31 (02) 205-209
    CrossrefPubMedGoogle Scholar
  • 4 Orr RA, Felmet KA, Han Y. , et al. Pediatric specialized transport teams are associated with improved outcomes. Pediatrics 2009; 124 (01) 40-48
    CrossrefPubMedGoogle Scholar
  • 5 Beyer III AJ, Land G, Zaritsky A. Nonphysician transport of intubated pediatric patients: a system evaluation. Crit Care Med 1992; 20 (07) 961-966
    CrossrefPubMedGoogle Scholar
  • 6 Kanter RK, Tompkins JM. Adverse events during interhospital transport: physiologic deterioration associated with pretransport severity of illness. Pediatrics 1989; 84 (01) 43-48
    PubMedGoogle Scholar
  • 7 Barry PW, Ralston C. Adverse events occurring during interhospital transfer of the critically ill. Arch Dis Child 1994; 71 (01) 8-11
    CrossrefPubMedGoogle Scholar
  • 8 Gunz AC, Dhanani S, Whyte H. , et al. Identifying significant and relevant events during pediatric transport: a modified Delphi study. Pediatr Crit Care Med 2014; 15 (07) 653-659
    CrossrefPubMedGoogle Scholar
  • 9 Bellander B-M, Cantais E, Enblad P. , et al. Consensus meeting on microdialysis in neurointensive care. Intensive Care Med 2004; 30 (12) 2166-2169
    CrossrefPubMedGoogle Scholar
  • 10 Blay J-Y, Bonvalot S, Casali P. , et al; GIST consensus meeting panelists. Consensus meeting for the management of gastrointestinal stromal tumors. Report of the GIST Consensus Conference of 20–21 March 2004, under the auspices of ESMO. Ann Oncol 2005; 16 (04) 566-578
    CrossrefPubMedGoogle Scholar
  • 11 Braylan RC, Orfao A, Borowitz MJ, Davis BH. Optimal number of reagents required to evaluate hematolymphoid neoplasias: results of an international consensus meeting. Cytometry 2001; 46 (01) 23-27
    CrossrefPubMedGoogle Scholar
  • 12 Fine J-D, Eady RA, Bauer EA. , et al. The classification of inherited epidermolysis bullosa (EB): Report of the Third International Consensus Meeting on Diagnosis and Classification of EB. J Am Acad Dermatol 2008; 58 (06) 931-950
    Google Scholar
  • 13 Fink A, Kosecoff J, Chassin M, Brook RH. Consensus methods: characteristics and guidelines for use. Am J Public Health 1984; 74 (09) 979-983
    CrossrefPubMedGoogle Scholar
  • 14 Land JA, Evers JL. Risks and complications in assisted reproduction techniques: Report of an ESHRE consensus meeting. Hum Reprod 2003; 18 (02) 455-457
    CrossrefPubMedGoogle Scholar
  • 15 Nair R, Aggarwal R, Khanna D. Methods of formal consensus in classification/diagnostic criteria and guideline development. Semin Arthritis Rheum 2011; 41 (02) 95-105
    CrossrefPubMedGoogle Scholar
  • 16 Tytgat GN, Heading RC, Müller-Lissner S. , et al. Contemporary understanding and management of reflux and constipation in the general population and pregnancy: a consensus meeting. Aliment Pharmacol Ther 2003; 18 (03) 291-301
    CrossrefPubMedGoogle Scholar
  • 17 Wargocki P, Sundell J, Bischof W. , et al. Ventilation and health in non-industrial indoor environments: report from a European multidisciplinary scientific consensus meeting (EUROVEN). Indoor Air 2002; 12 (02) 113-128
    CrossrefPubMedGoogle Scholar
  • 18 Bigham MT, Schwartz HP. ; Ohio Neonatal/Pediatric Transport Quality Collaborative. Quality metrics in neonatal and pediatric critical care transport: a consensus statement. Pediatr Crit Care Med 2013; 14 (05) 518-524
    CrossrefPubMedGoogle Scholar
  • 19 Schwartz HP, Bigham MT, Schoettker PJ, Meyer K, Trautman MS, Insoft RM. ; American Academy of Pediatrics Section on Transport Medicine. Quality Metrics in Neonatal and Pediatric Critical Care Transport: A National Delphi Project. Pediatr Crit Care Med 2015; 16 (08) 711-717
    CrossrefPubMedGoogle Scholar
  • 20 Plint A, Stang AS, Calder LA. ; Priorities in Patient Safety Research in Emergency Medicine Consensus Panel. Establishing priorities for patient safety research in the emergency department: a multidisciplinary consensus panel. Int J Emerg Med 2015; 8: 1 . Doi: 10.1186/s12245-014-0049-9
    CrossrefPubMedGoogle Scholar
  • 21 Dhanani S. . Planning Meeting to Develop an International Interdisciplinary Research Network. Meetings, Planning and Dissemination Grant Final Report. Ottawa, Canada; 2012
    PubMedGoogle Scholar
  • 22 Goldstein B, Giroir B, Randolph A. ; International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005; 6 (01) 2-8
    CrossrefPubMedGoogle Scholar
  • 23 Maternal and Newborn Health/Safe Motherhood Unit WHO (institution). Thermal protection of the newborn: a practical guide. 1997 http://apps.who.int/iris/bitstream/10665/63986/1/WHO_RHT_MSM_97.2.pdf . Accessed February 10, 2016
    PubMedGoogle Scholar
  • 24 Coates BM, Vavilala MS, Mack CD. , et al. Influence of definition and location of hypotension on outcome following severe pediatric traumatic brain injury. Crit Care Med 2005; 33 (11) 2645-2650
    CrossrefPubMedGoogle Scholar
  • 25 Haque IU, Zaritsky AL. Analysis of the evidence for the lower limit of systolic and mean arterial pressure in children. Pediatr Crit Care Med 2007; 8 (02) 138-144
    CrossrefPubMedGoogle Scholar
  • 26 Lander A. Paediatric fluid and electrolyte therapy guidelines. Surgery 2008; 26 (07) 283-287
    PubMedGoogle Scholar
  • 27 Moritz ML, Ayus JC. Disorders of water metabolism in children: hyponatremia and hypernatremia. Pediatr Rev 2002; 23 (11) 371-380
    PubMedGoogle Scholar
  • 28 Bockenkamp B, Vyas H. Understanding and managing acute fluid and electrolyte disturbances. Curr Paediatr 2003; 13 (07) 520-528
    CrossrefPubMedGoogle Scholar
  • 29 Rodríguez-Soriano J. Potassium homeostasis and its disturbances in children. Pediatr Nephrol 1995; 9 (03) 364-374
    CrossrefPubMedGoogle Scholar
  • 30 Lehnhardt A, Kemper MJ. Pathogenesis, diagnosis and management of hyperkalemia. Pediatr Nephrol 2011; 26 (03) 377-384
    CrossrefPubMedGoogle Scholar
  • 31 Masilamani K, van der Voort J. The management of acute hyperkalaemia in neonates and children. Arch Dis Child 2012; 97 (04) 376-380
    CrossrefPubMedGoogle Scholar
  • 32 Lemon V, Stockwell DC. Automated detection of adverse events in children. Pediatr Clin North Am 2012; 59 (06) 1269-1278
    CrossrefPubMedGoogle Scholar
  • 33 Dickerman MJ, Jacobs BR, Vinodrao H, Stockwell DC. Recognizing hypoglycemia in children through automated adverse-event detection. Pediatrics 2011; 127 (04) e1035-e1041
    CrossrefPubMedGoogle Scholar
  • 34 Kyle UG, Coss Bu JA, Kennedy CE, Jefferson LS. Organ dysfunction is associated with hyperglycemia in critically ill children. Intensive Care Med 2010; 36 (02) 312-320
    CrossrefPubMedGoogle Scholar
  • 35 Faustino EVS, Bogue CW. Relationship between hypoglycemia and mortality in critically ill children. Pediatr Crit Care Med 2010; 11 (06) 690-698
    CrossrefPubMedGoogle Scholar
  • 36 Cornblath M, Hawdon JM, Williams AF. , et al. Controversies regarding definition of neonatal hypoglycemia: suggested operational thresholds. Pediatrics 2000; 105 (05) 1141-1145
    CrossrefPubMedGoogle Scholar
  • 37 Kalhan S, Peter-Wohl S. Hypoglycemia: what is it for the neonate?. Am J Perinatol 2000; 17 (01) 11-18
    Article in Thieme ConnectPubMedGoogle Scholar
  • 38 Del Castillo J, López-Herce J, Matamoros M. , et al; Iberoamerican Pediatric Cardiac Arrest Study Network RIBEPCI. Hyperoxia, hypocapnia and hypercapnia as outcome factors after cardiac arrest in children. Resuscitation 2012; 83 (12) 1456-1461
    CrossrefPubMedGoogle Scholar
  • 39 Flin R, Winter J, Cakil Sarac MR. Human factors in patient safety: review of topics and tools. World Health Organization (WHO). 2009 http://www.who.int/patientsafety/research/methods_measures/human_factors/human_factors_review.pdf . Accessed February 10, 2016
    PubMedGoogle Scholar
  • 40 Health Canada. Clinical Safety Data Management Definitions and Standards for Expedited Reporting. 1995 http://www.hc-sc.gc.ca/dhp-mps/alt_formats/hpfb-dgpsa/pdf/prodpharma/e2a-eng.pdf . Accessed February 10, 2016
    PubMedGoogle Scholar
  • 41 Woodward RM, Insoft RM, Kleinman ME. , eds. Guidelines for Air and Ground Transport. 3rd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2006: 1-529 . Available at http://ebooks.aappublications.org/content/9781581105124/9781581105124.
    Google Scholar
  • 42 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
    CrossrefPubMedGoogle Scholar
  • 43 Ontario Agency for Health Protection and Promotion (Public Health Ontario) PIDAC. Best Practices for Surveillance of Health Care-Associated Infections: In Patient and Resident Populations. 3rd ed. Toronto, ON, Canada: Queen's Printer for Ontario; 2014
    Google Scholar
  • 44 Khemani RG, Smith LS, Zimmerman JJ, Erickson S. ; Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: definition, incidence, and epidemiology: proceedings from the Pediatric Acute Lung Injury Consensus Conference. Pediatr Crit Care Med 2015; 16 (05) (Suppl. 01) S23-S40
    CrossrefPubMedGoogle Scholar
  • 45 Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988; 16 (03) 128-140
    CrossrefPubMedGoogle Scholar
  • 46 Papson JPN, Russell KL, Taylor DM. Unexpected events during the intrahospital transport of critically ill patients. Acad Emerg Med 2007; 14 (06) 574-577
    CrossrefPubMedGoogle Scholar