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

Byline: Erik Jan Lieshout (1,2), Rien Vos (3), Jan M. Binnekade (1), Rob Haan (3), Marcus J. Schultz (1,4), Margreeth B. Vroom (1) Keywords: Transportation ofpatients; Patient transfer; Interhospital transfer; Critical care; Questionnaire; Conjoint analysis 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]a-=a-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]a-=a---3.1) and transport facilities (standard ambulance [beta]a-=a---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]a-=a---0.6, arterial oxygenation [beta]a-=a---0.8, level of peep [beta]a-=a---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. Author Affiliation: (1) Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105a-AZ, Amsterdam, Netherlands (2) Mobile Intensive Care Unit, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105a-AZ, Amsterdam, Netherlands (3) Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105a-AZ, Amsterdam, Netherlands (4) Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105a-AZ, Amsterdam, Netherlands Article History: Registration Date: 22/01/2008 Received Date: 15/07/2007 Accepted Date: 17/01/2008 Online Date: 19/02/2008