Quality metrics in neonatal and pediatric critical care transport: a consensus statement.

OBJECTIVES: The transport of neonatal and pediatric patients to tertiary care medical centers for specialized care demands monitoring the quality of care delivered during transport and its impact on patient outcomes. Accurate assessment of quality indicators and patient outcomes requires the use of a standard language permitting comparisons among transport programs. No consensus exists on a set of quality metrics for benchmarking transport teams. The aim of this project was to achieve consensus on appropriate neonatal and pediatric transport quality metrics.

DESIGN: Candidate quality metrics were identified through literature review and those metrics currently tracked by each program. Consensus was governed by nominal group technique. Metrics were categorized in two dimensions: Institute of Medicine quality domains and Donabedian's structure/process/outcome framework.

SETTING: Two-day Ohio statewide quality metrics conference.

SUBJECTS: Nineteen transport leaders and staff representing six statewide neonatal/pediatric specialty programs convened to achieve consensus.

MEASUREMENT AND MAIN RESULTS: Two hundred fifty-seven performance metrics relevant to neonatal/pediatric transport were identified. Eliminating duplicate and overlapping metrics resulted in 70 candidate metrics. Nominal group methodology yielded 23 final quality metrics, the largest portion representing Donabedian's outcome category (n = 12, 52%) and the Institute of Medicine quality domains of effectiveness (n = 7, 30%) and safety (n = 9, 39%). Sample final metrics include measurement of family presence, pain management, intubation success, neonatal temperature control, use of lights and sirens, and medication errors. Lastly, a definition for each metric was established and agreed upon for consistency among institutions.

CONCLUSIONS: This project demonstrates that quality metrics can be achieved through consensus building and provides the foundation for benchmarking among neonatal and pediatric transport programs and quality improvement projects.