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Quality Metrics in Neonatal and Pediatric Critical Care Transport: A National Delphi Project*

Schwartz, Hamilton P. MD1; Bigham, Michael T. MD2; Schoettker, Pamela J. MS3; Meyer, Keith MD4; Trautman, Michael S. MD5; Insoft, Robert M. MD6

Pediatric Critical Care Medicine: October 2015 - Volume 16 - Issue 8 - p 711–717
doi: 10.1097/PCC.0000000000000477
Feature Articles

Objectives: The transport of neonatal and pediatric patients to tertiary care facilities for specialized care demands monitoring the quality of care delivered during transport and its impact on patient outcomes. In 2011, pediatric transport teams in Ohio met to identify quality indicators permitting comparisons among programs. However, no set of national consensus quality metrics exists for benchmarking transport teams. The aim of this project was to achieve national consensus on appropriate neonatal and pediatric transport quality metrics.

Design: Modified Delphi technique.

Setting: The first round of consensus determination was via electronic mail survey, followed by rounds of consensus determination in-person at the American Academy of Pediatrics Section on Transport Medicine’s 2012 Quality Metrics Summit.

Subjects: All attendees of the American Academy of Pediatrics Section on Transport Medicine Quality Metrics Summit, conducted on October 21–23, 2012, in New Orleans, LA, were eligible to participate.

Measurements and Main Results: Candidate quality metrics were identified through literature review and those metrics currently tracked by participating programs. Participants were asked in a series of rounds to identify “very important” quality metrics for transport. It was determined a priori that consensus on a metric’s importance was achieved when at least 70% of respondents were in agreement. This is consistent with other Delphi studies. Eighty-two candidate metrics were considered initially. Ultimately, 12 metrics achieved consensus as “very important” to transport. These include metrics related to airway management, team mobilization time, patient and crew injuries, and adverse patient care events. Definitions were assigned to the 12 metrics to facilitate uniform data tracking among programs.

Conclusions: The authors succeeded in achieving consensus among a diverse group of national transport experts on 12 core neonatal and pediatric transport quality metrics. We propose that transport teams across the country use these metrics to benchmark and guide their quality improvement activities.

1Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children’s Hospital, University of Cincinnati School of Medicine, Cincinnati, OH.

2Division of Critical Care Medicine, Department of Pediatrics, Akron Children’s Hospital, Northeast Ohio Medical University, Akron, OH.

3James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital, Cincinnati, OH.

4Division of Critical Care Medicine, Department of Pediatrics, Miami Children’s Hospital, Miami, FL.

5Division of Neonatology, Department of Pediatrics, James W. Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN.

6Department of Pediatrics, Brown University Alpert School of Medicine, Providence, RI.

*See also p. 775.

Dr. Schoettker received support for manuscript writing/review; received provision of writing assistance, medicines, equipment, or administrative support; and received support for manuscript preparation (Dr. Schoettker is employed full-time by the Cincinnati Children's Hospital Medical Center as a medical writer. She works with many clinicians to help them publish their research). Dr. Trautman received support for travel from the American Academy of Pediatrics (lectures not specifically related to this). The remaining authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: Hamilton P. Schwartz, MD, Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children’s Hospital, 3333 Burnet Avenue, Cincinnati, OH 45229. E-mail:

©2015The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies