Pediatric Respirology and Critical Care Medicine

LETTER TO EDITOR
Year
: 2020  |  Volume : 4  |  Issue : 4  |  Page : 58--59

Reduction of complications in interhospital transport of critically ill infants: Impact of a standardized neonatal referral workflow and specialized neonatal transport team at the Hong Kong children’s hospital


Yuet Yee Chee, Rosanna Ming-Sum Wong, Godfrey Chi-Fung Chan 
 Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Kowloon, Hong Kong

Correspondence Address:
Yuet Yee Chee
Doctors’ Office, 9/f, Tower B, Hong Kong Children’s Hospital, 1 Shing Cheong Road, Kowloon Bay, Kowloon.
Hong Kong




How to cite this article:
Chee YY, Wong RM, Chan GC. Reduction of complications in interhospital transport of critically ill infants: Impact of a standardized neonatal referral workflow and specialized neonatal transport team at the Hong Kong children’s hospital.Pediatr Respirol Crit Care Med 2020;4:58-59


How to cite this URL:
Chee YY, Wong RM, Chan GC. Reduction of complications in interhospital transport of critically ill infants: Impact of a standardized neonatal referral workflow and specialized neonatal transport team at the Hong Kong children’s hospital. Pediatr Respirol Crit Care Med [serial online] 2020 [cited 2021 Dec 7 ];4:58-59
Available from: https://www.prccm.org/text.asp?2020/4/4/58/320779


Full Text



An article “Clinical Outcomes of Critically Ill Infants Requiring Interhospital Transport to a Paediatric Tertiary Centre in Hong Kong” was previously published by Leung et al. at the Pediatric Respirology and Critical Care Medicine in 2019.[1] This paper retrospectively reviewed the characteristics and clinical outcomes of all infants transported from the neonatal units of different regional hospitals to a tertiary neonatal intensive care unit (NICU) or cardiac intensive care unit in Hong Kong from August 1, 2013, to July 31, 2016. During that review period, no specialized neonatal transport team has been formed yet. Salient findings from this review included inadequate documentation of physiological parameters during transport (91.4% with missing documentation), while close to half of the patients (44.1%) had complications on admission.

Commencement of clinical service of the NICU at the newly opened Hong Kong Children’s Hospital (HKCH) was started in July 2019. HKCH NICU mainly takes care of neonates transferred from other hospitals with neonatal surgical problems. A standardized protocol is developed comprising workflow on case referral, systematic clinical handover via telephone conferencing, and pre-transportation preparation (with specific neonatal transport equipment bag, medications for use during transport together with body-weight specific resuscitation chart to minimize medication error). Interhospital transport of critically ill infants are now performed by a designated and specialized critical care transport team, comprising medical and nursing staff equipped with training on neonatal transport. Critical care transport will be performed by at least one doctor who is a pediatric specialist and one nurse from transport roster (nurses with prior training on neonatal transport at HKCH). We reviewed our interhospital neonatal intensive care transport data from July 2019 to July 2020 [Table 1]. The data only included neonatal transport from the referring hospital to the HKCH. A total of 48 infants with a mean gestational age of 32.2 ± 5.0 weeks and birth weight of 1800 ± 951g were included in the study. Patient characteristics and medical complexity (including ventilator and/or inotropic support) during transport were comparable to the previous cohort.[1] Documentation of physiological parameters during transport was available for all cases (compared with only 8.6% in the previous cohort [P < 0.05]). Serious or critical (or both) complications were significantly lower in our current cohort (25%) compared with the previous cohort (44.1%, P < 0.05). Significantly less interventions were needed during transport (or within 1h after transport) in our cohort (6.3%) compared with the previous cohort (23.0%, P < 0.05).{Table 1}

To conclude, complications of transport of critically ill infants could be significantly reduced if the transport is performed by a designated and specialized critical care transport team, with fewer unplanned events during transport.

Acknowledgment

The authors sincerely thank all the doctors and nursing staff of the critical care transport team and neonatal intensive unit of the Hong Kong Children’s Hospital, Hong Kong

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Leung KK, Lee SL, Wong MS, Wong WH, Yung TC. Clinical outcomes of critically ill infants requiring interhospital transport to a paediatric tertiary centre in Hong Kong. Pediatr Respirol Crit Care Med 2019;3:28-35.