The QUality of Interhospital Transportation in the Euregion Meuse-Rhine (QUIT-EMR) score: a cross-validation study

OBJECTIVES: Interhospital transports of critically ill patients are high-risk medical interventions. Well-established parameters to quantify the quality of transports are currently lacking. We aimed to develop and cross-validate a score for interhospital transports. SETTING: An expert panel developed a score for interhospital transport by a Mobile Intensive Care Unit (MICU), the QUality of Interhospital Transportation in the Euregion Meuse-Rhine (QUIT-EMR) score. The QUIT-EMR score is an overall sum score that includes component scores of monitoring and intervention variables of the neurological (proxy for airway patency), respiratory and circulatory organ systems, ranging from −12 to +12. A score of 0 or higher defines an adequate transport. The QUIT-EMR score was tested to help to quantify the quality of transport. PARTICIPANTS: One hundred adult patients were randomly included and the transport charts were independently reviewed and classified as adequate or inadequate by four transport experts (ie, anaesthetists/intensivists). OUTCOME MEASURES: Subsequently, the level of agreement between the QUIT-EMR score and expert classification was calculated using Gwet’s AC(1). RESULTS: From April 2012 to May 2014, a total of 100 MICU transports were studied. The median (IQR) QUIT-EMR score was 1 (0–2). Experts classified six transports as inadequate. The percentage agreement between the QUIT-EMR score and experts’ classification for adequate/inadequate transport ranged from 84% to 92% (Gwet’s AC(1)0.81–0.91). The interobserver agreement between experts was 87% to 94% (Gwet’s AC(1)0.89–0.98). CONCLUSION: The QUIT-EMR score is a novel validated tool to score MICU transportation adequacy in future studies contributing to quality control and improvement. TRIAL REGISTRATION NUMBER: NTR 4937.