Using Epidemiology and Pediatric Direction to Inform Air Medical Quality Improvement.

Introduction: Pediatric air transport research is limited, especially scene transport. Study purpose was to review transport epidemiology, outcomes, and documentation to inform development of a pediatric flight quality improvement (QI) program and outreach.

Methods: Study design was ongoing review and analysis of flight, ED, EMS and hospital records over 2 years from children ≤ 18 years transported by a regional flight program. Mission type included trauma, medical, scene and interfacility. Records were reviewed monthly by a pediatric medical director (PMD) with ongoing QI and educational initiatives. Peer review was added in year two. Demographic and outcome variables included weight, times, procedures, pain scales, Glasgow Coma Scale (GCS), medications, disposition, etc. Two QI focus areas were studied using QI Macros®: weight and pain documentation.

Results: Children accounted for 8% of total flights (165/2076). Transport was 58% scene; 42% interfacility. Median dispatch to arrival time was 21 minutes. Saturday accounted for 24% of flights. Mean scene GCS was 12; 39 (24%) patients were intubated. Scene weight in kilograms improved 18% and pain documentation improved from 49% to 79% during the study.

Conclusion: Addition of PMD, peer and outcome review processes provided opportunities for improving pediatric transport QI initiatives and targeted outreach education.