Development of consensus guidelines for classification of emergent neonatal transports using a Delphi process

BACKGROUND: The transport of neonates to tertiary and quaternary neonatal intensive care units occurs frequently in North America, particularly for neonates requiring emergent intervention. The timely stabilization and transfer of a critically ill neonate requiring higher level of care is imperative for optimal clinical outcomes. There is no consensus on the definition of "emergent" related to dispatch of a transport team. However, some utilize a time frame of 30 minutes from referral center request based on illness severity and/or risk. Current definitions of illness severity and/or risk are institution-specific, lacking standardization. The development of consensus-driven guidelines for emergent neonatal transport criteria will provide a framework adaptable across diverse healthcare settings to standardize decision making, resulting in comparable data and outcome measures. OBJECTIVE: The aim of this project is to develop expert consensus criteria for neonatal emergent interfacility transport. DESIGN/METHODS: Following review of available literature and institution-specific guidelines and policies, a subset of neonatologists within the Children's Hospitals Neonatal Consortium (CHNC) Transport Focus Group compiled a proposed list of emergent neonatal criteria. These criteria were divided into three categories: (1) diagnosis, (2) clinical sign, or (3) specialized equipment and/or resources required. Using the Delphi process, CHNC transport leaders voted in two rounds for consensus. RESULTS: Round 1 of surveys received responses from 31 of 49 (63%) CHNC sites and achieved 100% agreement on criteria, defined as >80% consensus of each criterion. Revisions and additions suggested by participants in Round 1 were incorporated into the Round 2 survey. Round 2 of surveys received responses from 40 of 49 (82%) CHNC sites and again received 100% agreement on criteria. CONCLUSION(S): All proposed conditions reached consensus for inclusion, falling into one of three major categories. Consensus-derived criteria for emergent neonatal transport will provide a standardized framework for triage, prioritization and resource utilization. Additionally, these guidelines should facilitate national and international benchmarking, improve efficiency and support neonatal outcome-based research across North America.