Measuring the performance of an inter-hospital transport service
- Padmanabhan Ramnarayan, Children’s Acute Transport Service (CATS), 44-B Bedford Row, London WC1R 4LL, UK;
- Accepted 15 November 2008
- Published Online First 27 January 2009
Most district general hospital (DGH) paediatricians will have referred critically ill children to a retrieval team at some point in their career. Inter-hospital transport services have developed in response to the centralisation of specialist services such as intensive care, with the aim of ensuring safe and rapid transport of sick children to tertiary centres.1–3 In many parts of the UK, retrievals are undertaken by staff despatched from the receiving intensive care unit (ICU), although dedicated regional transport teams, similar to those in North America and Australia, have also evolved recently for neonatal and paediatric transfers.4–6 Regional transport teams allow concentration of expertise and often serve as a single point of contact for immediate advice, information on an appropriate ICU bed and access to a specialist team.
WHY MEASURE THE PERFORMANCE OF A TRANSPORT TEAM?
Clinicians, commissioners and patients justifiably expect specialist services to deliver high quality, cost-effective care. While a number of quality indicators have been proposed for intensive care,7 there is currently no consensus on how the performance of an inter-hospital transport service can be measured. This is likely to be a significant drawback in the future. Ongoing changes in the NHS such as re-organisation of children’s emergency services, implementation of the recommendations of the Darzi Next Steps Review, and proliferation of managed clinical networks are all likely to greatly increase the need for safe and efficient patient transfer between ambulatory, secondary and tertiary care settings.8–11 Payment-by-results is also likely to generate greater competition between existing NHS providers and encourage the involvement of independent sector providers in patient transport.12 The absence of agreed key performance indicators or reference values means that transport teams will be unable to measure their own performance over time and commissioners will not be able to compare services or benchmark performance, raising …