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Decision making in interhospital transport of critically ill patients: national questionnaire survey among critical care physicians.

van Lieshout EJ, de Vos R, Binnekade JM, de Haan R, Schultz MJ, Vroom MB - Intensive Care Med (2008)

Bottom Line: The type of escorting personnel (paramedic only: beta = -3.1) and transport facilities (standard ambulance beta = -1.21) had the greatest negative effect on preference for transportability.Age, cardiac arrhythmia, and the indication for transport had no significant effect.Further clinical research should tailor transport conditions to optimize the use of expensive resources in those inevitable road trips.

View Article: PubMed Central - PubMed

Affiliation: Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands. E.J.vanLieshout@amc.nl

ABSTRACT

Objective: This study assessed the relative importance of clinical and transport-related factors in physicians' decision-making regarding the interhospital transport of critically ill patients.

Methods: The medical heads of all 95 ICUs in The Netherlands were surveyed with a questionnaire using 16 case vignettes to evaluate preferences for transportability; 78 physicians (82%) participated. The vignettes varied in eight factors with regard to severity of illness and transport conditions. Their relative weights were calculated for each level of the factors by conjoint analysis and expressed in beta. The reference value (beta = 0) was defined as the optimal conditions for critical care transport; a negative beta indicated preference against transportability.

Results: The type of escorting personnel (paramedic only: beta = -3.1) and transport facilities (standard ambulance beta = -1.21) had the greatest negative effect on preference for transportability. Determinants reflecting severity of illness were of relative minor importance (dose of noradrenaline beta = -0.6, arterial oxygenation beta = -0.8, level of peep beta = -0.6). Age, cardiac arrhythmia, and the indication for transport had no significant effect.

Conclusions: Escorting personnel and transport facilities in interhospital transport were considered as most important by intensive care physicians in determining transportability. When these factors are optimal, even severely critically ill patients are considered able to undergo transport. Further clinical research should tailor transport conditions to optimize the use of expensive resources in those inevitable road trips.

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Related in: MedlinePlus

Relative weight (expressed in β, 95% confidence interval) of determinants influencing the decision on interhospital IC transport. ref, Reference value; PEEP, positive end-expiratory pressure; ventric, ventricular; IC, intensive care
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Fig1: Relative weight (expressed in β, 95% confidence interval) of determinants influencing the decision on interhospital IC transport. ref, Reference value; PEEP, positive end-expiratory pressure; ventric, ventricular; IC, intensive care

Mentions: The impact of the determinants in the decision making on transportability is displayed in Fig. 1. Those with the largest negative effects on preference for transportability were the type of escorting personnel [paramedic only: β = –3.1 (–3.7 to –2.5); IC nurse and paramedic: β = –2.1 (–2.5 to –1.7); team of IC physician, nurse, and paramedic: β = –1.0 (–1.2 to –0.8); standard ambulance: β = –1.21 (–1.7 to –0.8)]. Determinants reflecting the critically ill patient's condition and intensity of treatment were scored to be of relative minor importance [dose of noradrenaline: β = –0.6 (–1.0 to –0.1); arterial oxygenation β = –0.8 (–1.3 to –0.4); level of PEEP β = –0.6 (–1.0 to –0.1)]. Age [60 years: β = 0.1 (–0.2 to 0.3); 80 years: β = 0.1 [–0.4 to 0.7)], cardiac arrhythmia [β = 0.1 (–0.4 to 0.5)], and the indication for transport (β = –0.3 (–0.8 to 0.1)] had no significant effect on the preference for transportability (Fig. 1).Fig. 1


Decision making in interhospital transport of critically ill patients: national questionnaire survey among critical care physicians.

van Lieshout EJ, de Vos R, Binnekade JM, de Haan R, Schultz MJ, Vroom MB - Intensive Care Med (2008)

Relative weight (expressed in β, 95% confidence interval) of determinants influencing the decision on interhospital IC transport. ref, Reference value; PEEP, positive end-expiratory pressure; ventric, ventricular; IC, intensive care
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2480595&req=5

Fig1: Relative weight (expressed in β, 95% confidence interval) of determinants influencing the decision on interhospital IC transport. ref, Reference value; PEEP, positive end-expiratory pressure; ventric, ventricular; IC, intensive care
Mentions: The impact of the determinants in the decision making on transportability is displayed in Fig. 1. Those with the largest negative effects on preference for transportability were the type of escorting personnel [paramedic only: β = –3.1 (–3.7 to –2.5); IC nurse and paramedic: β = –2.1 (–2.5 to –1.7); team of IC physician, nurse, and paramedic: β = –1.0 (–1.2 to –0.8); standard ambulance: β = –1.21 (–1.7 to –0.8)]. Determinants reflecting the critically ill patient's condition and intensity of treatment were scored to be of relative minor importance [dose of noradrenaline: β = –0.6 (–1.0 to –0.1); arterial oxygenation β = –0.8 (–1.3 to –0.4); level of PEEP β = –0.6 (–1.0 to –0.1)]. Age [60 years: β = 0.1 (–0.2 to 0.3); 80 years: β = 0.1 [–0.4 to 0.7)], cardiac arrhythmia [β = 0.1 (–0.4 to 0.5)], and the indication for transport (β = –0.3 (–0.8 to 0.1)] had no significant effect on the preference for transportability (Fig. 1).Fig. 1

Bottom Line: The type of escorting personnel (paramedic only: beta = -3.1) and transport facilities (standard ambulance beta = -1.21) had the greatest negative effect on preference for transportability.Age, cardiac arrhythmia, and the indication for transport had no significant effect.Further clinical research should tailor transport conditions to optimize the use of expensive resources in those inevitable road trips.

View Article: PubMed Central - PubMed

Affiliation: Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands. E.J.vanLieshout@amc.nl

ABSTRACT

Objective: This study assessed the relative importance of clinical and transport-related factors in physicians' decision-making regarding the interhospital transport of critically ill patients.

Methods: The medical heads of all 95 ICUs in The Netherlands were surveyed with a questionnaire using 16 case vignettes to evaluate preferences for transportability; 78 physicians (82%) participated. The vignettes varied in eight factors with regard to severity of illness and transport conditions. Their relative weights were calculated for each level of the factors by conjoint analysis and expressed in beta. The reference value (beta = 0) was defined as the optimal conditions for critical care transport; a negative beta indicated preference against transportability.

Results: The type of escorting personnel (paramedic only: beta = -3.1) and transport facilities (standard ambulance beta = -1.21) had the greatest negative effect on preference for transportability. Determinants reflecting severity of illness were of relative minor importance (dose of noradrenaline beta = -0.6, arterial oxygenation beta = -0.8, level of peep beta = -0.6). Age, cardiac arrhythmia, and the indication for transport had no significant effect.

Conclusions: Escorting personnel and transport facilities in interhospital transport were considered as most important by intensive care physicians in determining transportability. When these factors are optimal, even severely critically ill patients are considered able to undergo transport. Further clinical research should tailor transport conditions to optimize the use of expensive resources in those inevitable road trips.

Show MeSH
Related in: MedlinePlus