Use of Flight Criteria to Reduce Number of Flights for Neonatal/Pediatric Transport Team

Purpose:
Helicopter emergency medical systems have improved survival in the adult trauma population. There is, however, a lack of clear data on the benefits of flight in pediatric and neonatal transport. There are also potential cost and safety issues associated with air transport.

Relevance/Significance:
There is currently no validated tool to help determine the appropriate mode of pediatric transport, and the decision for air transport is often debated. Most agree that a flight is warranted if the time saved by flying will improve the patient's outcome. In reality, other factors also impact the decision to fly, including patient acuity, referring facility, and competition with other hospitals. We created a tool to guide appropriate flight utilization.

Strategy and Implementation:
At our Midwest tertiary children's hospital, the neonatal-pediatric transport team serves a 300 mile radius, including urban and rural communities, and performs approximately 1200 transports per year, of which about 23% are by air. We created a flight tool to help guide our decision making process when choosing the mode of transport for each mission. This tool included evaluation of patient acuity, weather, distance, traffic, team availability, and physician request. Scores were assigned to each category, and the total score guided the decision to fly verses drive. Referring physician request was pre-determined as an absolute reason for flight, weather permitting. We initiated use of these criteria on July 1, 2012 and prospectively employed the tool until June 30, 2013. We then retrospectively applied the criteria to trips from July 1, 2011-June 30, 2012 for comparison.

Evaluation:
We had adequate data to evaluate 234 of 252 flights (93%) from 2011-2012 and 233 of 249 flights (94%) in 2012-2013. The number of flights that did not meet criteria to fly was unchanged, despite implementation of a flight tool (33% retrospective versus 31% prospective, p=0.51). Of the flights that did not meet criteria to fly, we flew 67% of the time for physician request.

Implications for Practice:
Application of pre-determined flight criteria did not change the number of flights. Two-thirds of the flights that did not meet criteria to fly were due to referring physician request. We will continue to refine our tool and provivde education to referral centers on use of air transport services.