Enhancing pre-hospital pediatric care during ambulance transport to tertiary care hospitals: a quality improvement initiative

Background. Our emergency department receives critically ill children transported by ambulance. While most children received appropriate pre-hospital stabilization, certain areas needed improvement. Our study aims to improve the quality of pre-hospital care and provide “Excellent” pre-hospital care for at least 90% of children between 1 month to 12 years who are transported in ambulances to our pediatric ED over eight weeks. Methods. This study is a quality improvement (QI) study conducted in our Pediatric ED in 3 phases: assessment, implementation, and sustenance. The quality of pre-hospital care was graded based on consensus from the QI meeting as follows: <50% – Suboptimal, 50-75% – Optimal, and >75% – Excellent. Key interventions included training sessions, structured checklists, pre-arrival intimation, and registry documentation. Problem areas were analyzed using various QI tools such as fishbone diagrams, PDSA cycles, Pareto charts, and P control charts. The paired t-test was used to analyze pre- and post-training results. Results. A total of 538 children were included in the study. A pre-test was conducted before the training session, and a post-test was conducted after the training completion. There was a statistically significant improvement in correct responses in the post-test (p < 0.0001). The quality of pre-hospital care improved from a baseline of 50.3% to 93.3%, and 96% of children received “Excellent” pre-hospital care during the study period. Conclusion. Awareness and education on pre-hospital care significantly improved the quality of care delivered. Sustained improvement will require continued support at various levels, beginning from the primary health care center. Filling out the transport checklist before transporting children, providing pre-arrival intimation to the tertiary care center, conducting monthly training sessions and routine briefing of the new protocols for staff members will be required for sustained improvement in pre-hospital care.