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Are interhospital transport teams de-skilling the DGH paediatricians?
  1. A P Winrow
  1. Kingston Hospital, Surrey; awinrow{at}kingstonhospital.nhs.uk

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As one of the referring hospital consultants to the South Thames combined transport service, I can attest to the successful service described in the paper by Doyle and Orr.1 However, it is rare for a transport team to be immediately available to collect a sick child. This delay compounded by the inevitable travelling time means that the referring unit needs to be able to stabilise and treat the sick child prior to the team’s arrival.

Concerns have been voiced that the availability of such teams de-skill paediatricians and place an increased burden on the “in-house” anaesthetists and intensivists. To examine this concern, data collected over the last 2 years from our paediatric high dependency unit (HDU) were reviewed. 153 children were admitted with 35% originating from the A&E department. The vast majority were medical type patients with 42% suffering respiratory problems, 1% required nasal CPAP and 13% required intubation and ventilation. Of these 63% were intubated by “in-house” anaesthetists. 25% of all admissions required transfer to a paediatric intensive care unit (PICU) by transport team. 71% of admissions to the HDU room were discharged to the in-patient ward. There were no deaths occurring in this HDU facility.

In view of the overall infrequency of intubation by local staff but the successful care of these patients, it would not seem as though transport teams are de-skilling the local teams. Indeed good communication and shared protocols enhance the local team’s work provided senior experienced staff are available to supervise care until the arrival of the transport team.

The above experience does highlight the benefit of a local HDU facility. Stabilisation and close monitoring is not only good practice, essential for patient care but should reduce the work of the transport team when it arrives. When funding and patterns of care are reviewed locally, more attention should be given to ensuring that local facilities in the form of HDU beds are available. They are not mini PICUs but they do have a purpose.

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