Organization and Mission

Children’s Hospital of San Diego (CHSD) is the San Diego region’s only designated pediatric trauma center and the only area hospital dedicated solely to pediatric care. Since CHSD first opened its doors in 1954, its mission has been “to restore, sustain and enhance the health and developmental potential of children.” More information is available at www.chsd.org.

The Emergency Transport Program was started in 1972, first for neonatal transport. When the hospital opened a pediatric ICU a second team was added for pediatric transport. CHSD transports approximately 1,000 pediatric and 800 neonatal patients annually.

Meeting Patient Needs
About five years ago, CHSD shifted to teams made up of a nurse and a respiratory therapist. Both members are completely cross-trained. With the approval from the respiratory care board, standard protocols were approved in advance, allowing both RTs and RNs to expand the scope of their capabilities. Although the nurse tends to be the primary staff member, they work as a team and responsibilities shift according to the needs of the patient. CHSD believes that the RN/RT teams are more effective because each team member understands the other’s functions. If necessary, it provides redundant capabilities within a single team.

Separate teams are dedicated to pediatrics and neonates and they are pre-assigned to transport responsibilities. Although combining teams might be a means of leveling the workload, CHSD has found that it provides better care by having dedicated teams. When teams are not involved in transport, they provide defined supplemental staffing within the hospital.

The RN/RT team approach was conceived to improve the quality of care and simplify the administration of the service.

Implementation Strategy
Before changing the staffing, it was necessary to convince the team medical directors of the benefits, and then the teams needed to be trained. Preconceptions about the capabilities of respiratory therapists were addressed through training and testing and by setting high thresholds for prior experience. Teams went through 48 hours of pediatric training followed by written and performance tests. Team members must have five years of experience before applying for a transport position.

Evaluation and Results
CHSD holds transport morbidity and mortality conferences with the medical director and medical control officer. These conferences are held in a confidential environment so all parties can speak candidly.

The RN/RT team concept has produced positive results and helped recruitment.

Education and Replication
The CHSD RN/RT team approach may have potential for replication by other services.