Factors associated with prolongation of transport times of emergency pediatric patients requiring transfer to a tertiary care center

Purpose: The purpose of this study was to determine factors associated with longer times to transport of emergency pediatric patients requiring tertiary care. Design: Retrospective case series. Setting: Emergency pediatric transport service. Participants: Infants and children transported by the transport service at the University of North Carolina Hospitals at Chapel Hill from January 1, 1988, to December 31, 1990. Main measurements: The time-to-request, the time from patient arrival at the referring hospital to the time when the request for transfer was received, and the ground time, defined as the time between the transport team's arrival at the referring hospital and their departure, were recorded for each transported patient. Results: Three hundred consecutive children 0 to 16 years (61% male) were transferred. Time-to-request was shorter for trauma patients (median 62 minutes, quartiles 29 and 153 minutes) than for medical patients (median 172 minutes, quartiles 83 and 508 minutes) (P = 0.0001). Infants, children, and adolescents had similar times-to-request of 147 minutes, 129 minutes, and 128 minutes, respectively (P = 0.91). Increased ground times were associated with diagnosis category (median of 40 minutes for medical patients vs 29 minutes for trauma patients) (P = 0.0001), with younger age (median of 46 minutes for infants, 35 minutes for children, and 28 minutes for adolescents) (P = 0.0001), and with the performance of major procedures (median of 35 minutes if no procedures were performed, 38 minutes if one procedure Has performed, and 54 minutes if two procedures were performed) (P = 0.039). After the transport team arrived, 13% (40/300) of patients required at least one major procedure prior to transport. Conclusions. Increased time-to-request for patients with medical diagnoses, increased ground times for younger patients and patients with medical diagnoses, and failure to perform necessary procedures contribute to a prolongation of the time to-transport of emergency pediatric patients. The magnitude of the impact of these longer transport times on outcome is unknown.