Pediatric and neonatal transport teams with and without a physician: A comparison of outcomes and interventions

OBJECTIVE: To determine whether a transport team composed of advanced practice nurses could function as effectively as a physician-nurse team, as measured by patient outcome. DESIGN: Observational cohort study. SETTING: The interfacility transport team at a tertiary care children's hospital. PATIENTS AND OTHER PARTICIPANTS: Fourteen transport nurses and 539 patients. METHODS: A transport team was studied during a previously planned change in composition from a physician-nurse team to a nurse-nurse team. Data were recorded by transport nurses and by subsequent review of the medical record during two 4-month periods, 1 before and 1 after the team change. Pediatric risk of mortality scores (a marker for degree of illness) were assigned for the periods before, during, and after transport. Transport time intervals, demographic data, and patient outcomes were also recorded. Data were assessed using frequency tables for discrete variables, as well as mean and standard deviation for continuous variables. For identification of group differences, χ test was used. MAIN OUTCOME MEASURES: Mortality, transport-related morbidity, overall transport times and interval times, and outcome of procedures performed by transport nurses. RESULTS: Five hundred thirty-nine data sheets were received: 228 before (group 1) and 311 after (group 2) the team change. Physicians attended 128 (56.1%) group 1 transports and 15 (4.82%) group 2 transports. There were no significant differences in mean pediatric risk of mortality scores between group 1 and group 2 patients. Mortality was equivalent. Group 2 transport times were significantly shorter than group 1 times. Transport nurses performed 8 intubations; all were successful. CONCLUSIONS: Outcomes for the 2 types of teams were equivalent. Nonphysician teams responded more quickly and spent less time at the referring facility.