Parental perspectives on the transfer process for critically ill children

Abstract

Objective: To understand parental stressors and identify potential stress-mitigators during interfacility transfer of critically ill children. Methods: Descriptive qualitative multi-case study using semi-structured interviews. This study involved caregivers of patients admitted to the Paediatric Critical Care Unit at Children’s Hospital, London Health Sciences Centre transported from outlying hospitals. Study participants were recruited through purposeful sampling. Interviews were recorded, transcribed verbatim and manually de-identified. Coding was performed by two independent coders using a standard method of content analysis to identify common themes. Results: Themes were identified and reached saturation after twelve interviews were completed. Children were admitted primarily from Northwestern and Southwestern Ontario, at distances ranging from 36 to 1146 km. Sixty-seven percent were transported by ground and 33% were transported by air ambulance. We identified stressors (patient pain and discomfort on transport, separation anxiety, feeling of being uninvolved, general anxiety about transport, cost and logistics of return trip home, lack of support systems/loneliness and leaving other family members behind) and stress-mitigators (parental accompaniment, immediate access to the child at accepting facility, parental involvement in care/comfort, support systems – other families in hospital, support systems – staff, communication with the parents/caregivers and trust toward the transport team) associated with the transport process. Conclusions: The current study identified important parent perspectives regarding the transfer of critically ill children. We recommend that stakeholders at referral centres, transport services and accepting facilities examine their current standards regarding transport processes to ensure relevant mitigators are incorporated into their programs to improve the transport experience for critically ill children and their families.