Table 2.

Challenges and strengths that may impact outcomes of emergent neonatal transport

Challenges
RN and RT staffing	Staffing is a common reason for declining transport and major contributor to delayed departure times. Transport team members are often pulled from inpatient assignments or called in from home. Staff expectations, lack of training, and variable shift times are factors that may affect transport outcomes.
Ambulance	If there is no dedicated rig onsite at the receiving hospital, factors including traffic and transport timing affect the ability for a team to quickly obtain ground transportation. Additional problems may include miscommunication with the ambulance company, lack of proper equipment in the rig, and seatbelts that restrict range of motion of team members. Of note, poor ambulance suspensions make for bumpy rides that may contribute to negative outcomes like intraventricular hemorrhage.
Air transport	Helicopter and fixed wing are characterized by low lighting, cramped spaces, and loud noises that restrict communication and access to the baby. The transport team may not be able to communicate with neonatologist at the receiving hospital because of noise and low cell signal in the air.
Administration	While transport brings in patients to the receiving hospital, it is not seen as a moneymaker. Teams feel a lack of support from administrations with respect to ensuring staff for transport and securing funding for skills days and equipment.
Intake form	Standardized transport forms may be dated, insufficient, or inaccurate. To get necessary clinical information, additional phone calls to the referral hospital may be required.
Strengths
Teamwork	Team configuration varies, and no one combination is recommended. Established working relationships among transport team members and experience doing transports together contributes to overall strength and performance. Dedicated teams often have significant experience working together and maintaining skills as a team.
Experience with referral hospitals	Experience with referral hospitals helps with managing expectations for transport. Good, open communication with referral hospitals may lead to staff at referral hospitals taking a more active role. Care coordination between receiving and referral hospitals is improved with access to a shared electronic medical record and/or video conferencing capabilities.
Planning	Prepare for anything because what will happen cannot be known. Teams may mentally prepare by pre-briefing and physically prepare by pre-stocking transport bags with equipment, common medications, and supplies necessary for a range of clinical scenarios.
Training	Training for transport team members varies widely. Also variable is the duration of training for new members.
Debriefing & quality improvement	Debriefing after transport and case review improve the quality of transports. Quality improvement efforts vary.
Outreach	Outreach programs based on feedback from referral hospitals help train staff at referral hospitals. These programs may improve relationships and communication between receiving and referral hospitals and patient care.
Hierarchy	Transport teams are characterized by some sort of hierarchical leadership. Leadership and support from those in supervisory roles is important to the success of transport.