ABSTRACT
OBJECTIVE: To describe the current scope of neonatal inter-facility transports. STUDY DESIGN: California databases were used to characterize infants transported in the first week after birth from 2009 to 2012. RESULTS: Transport of the 22 550 neonates was classified as emergent 9383 (41.6%), urgent 8844 (39.2%), scheduled 2082 (9.2%) and other 85 (0.4%). In addition, 2152 (9.5%) were initiated for delivery attendance. Most transports originated from hospitals without a neonatal intensive care unit (68%), with the majority transferred to regional centers (66%). Compared with those born and cared for at the birth hospital, the odds of being transported were higher if the patient's mother was Hispanic, <20 years old, or had a previous C-section. An Apgar score <3 at 10 min of age, cardiac compressions in the delivery room, or major birth defect were also risk factors for neonatal transport. CONCLUSION: As many neonates receive transport within the first week after birth, there may be opportunities for quality improvement activities in this area.
Subject(s)
Intensive Care Units, Neonatal/statistics & numerical data , Transportation of Patients/statistics & numerical data , California , Case-Control Studies , Databases, Factual , Female , Gestational Age , Humans , Infant, Extremely Low Birth Weight , Infant, Extremely Premature , Infant, Newborn , Male , Prospective Studies , Risk FactorsABSTRACT
OBJECTIVE: To develop a strategy to assess the quality of neonatal transport based on change in neonatal condition during transport. STUDY DESIGN: The Canadian Transport Risk Index of Physiologic Stability (TRIPS) score was optimized for a California (Ca) population using data collected on 21 279 acute neonatal transports, 2007 to 2009, using models predicting (2/3) and validating (1/3) mortality within 7 days of transport. Quality Change Point 10th percentile (QCP10), a benchmark of the greatest deterioration seen in 10% of the transports by top-performing teams, was established. RESULT: Compared with perinatal variables (0.79), the Ca-TRIPS had a validation receiver operator characteristic area for prediction of death of 0.88 in all infants and 0.86 in infants transported after day 7. The risk of death increased 2.4-fold in infants whose deterioration exceeded the QCP10. CONCLUSION: We present a practical, benchmarked, risk-adjusted, estimate of the quality of neonatal transport.
