6 de junho de 2011

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

Erik Jan van Lieshout, Rien de Vos, JanM. Binnekade, Rob de Haan, Marcus J. Schultz, MargreethB. Vroom
Intensive Care Med (2008) 34:1269–1273



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 β. The reference value (β = 0) was defined as the optimal conditions for critical care transport; a negative β indicated preference against transportability.

Results:
The type of escorting personnel (paramedic only: β = –3.1) and transport facilities (standard ambulance β = –1.21) had the greatest negative effect on preference for transportability. Determinants reflecting severity of illness were of relative minor importance (dose of noradrenaline β = –0.6, arterial 
oxygenation β = –0.8, level of peep β = –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.

Keywords:
Transportation of patients · Patient transfer · Interhospital transfer · Critical care · 
Questionnaire · Conjoint analysis


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