INFLUENCE OF REFERRING PHYSICIANS ON INTERVENTIONS BY A PEDIATRIC ANDNEONATAL CRITICAL CARE TRANSPORT TEAM

The objective of this study was to determine the influence of: a) pedi atrician versus nonpediatrician referrals on a transport team's therap eutic interventions and b) referring physician's year of graduation on interventions performed by the transport team. From November 1987 thr ough December 1989 we prospectively compared the therapeutic intervent ions performed by the critical care transport team on newborns and ped iatric patients with the referring physician's specialty and year of g raduation. The transport team (critical care physician [PL3 or greater ], registered respiratory therapist, critical care nurse), recorded al l therapeutic interventions, including both procedural and pharmacolog ic, for 213 newborn and 149 consecutive pediatric transports, Referrin g physicians were categorized as pediatricians and nonpediatricians. D ata were analyzed by analysis of variance, chi(2), or linear regressio n. All patients were admitted to either the pediatric or the neonatal intensive care unit, and over 80% of both age groups received assisted ventilation. Newborns referred by nonpediatricians required significa ntly more procedural interventions (2.64 vs 1.91, P = 0.016) than thos e referred by pediatricians, The opposite relationship was observed am ong pediatric patients in that children referred by pediatricians rece ived more frequent intervention (P = 0.008) than those referred by non pediatricians. There was a significant inverse relationship between th e referring physician's year of medical school graduation and the numb er of therapeutic interventions (total interventions = 6.17 - 0.040 x graduation year, P = 0.01) and procedural interventions (procedural in terventions = 3.54 - 0.024 x graduation year, P = 0.01). We found that the referring physicians' medical training affected the number of int erventions their patients received. Similarly, patients were likely to receive more interventions if the referral physician's training was n ot recent, These data have educational implications and support the co ncepts of continuing medical education, recertification, and maintenan ce of skills among physicians providing care to critically ill newborn s and pediatric patients.