Development of the Database
Database Content
With a philosophical understanding of a “database” in hand, the remainder of the chapter should build into the tangible tools necessary to build and interface with a neonatal and/or pediatric transport database.
The primary question driving the development of your database should be simple: “What are you trying to accomplish?” For example, if the goal of a database is target geographic areas for marketing, that database will likely include a detailed list of the specific referral hospital associated with each transport request or completed transport. This is a simple enough concept; however, this “marketing” database will not be adequate if the goal is to answer outcomes research questions. Outcomes research answers would come from 1 of 2 avenues: a separate database uniquely designed with an outcomes focus or a more comprehensive single database built to accomplish both marketing and outcomes research goals.Building a locally useful database will be addressed shortly, but there are existing databases worthy of review. The Congenital Heart Surgeons Society is a group of 100 pediatric heart surgeons (65 institutions) whose members recognized in 1985 that pooled experience from multiple institutions was the only way that its members could improve their ability to determine the best methods of treating patients with congenital heart disease. That vision of what the pooled experience could accomplish was developed into the Congenital Heart Surgeons' Society Data Center (CHSSDC), with a mission to “improve care...through collaborative research” and a vision that “the data center is a research engine and an academic resource which serves to extract knowledge from the collective clinical experience of the membership.”1 The focus of the CHSSDC is clear. Other fields in medicine have embarked on database development, with varying effectiveness.
Other examples of current databases relative to neonatal and pediatric care include the Vermont Oxford Network (VON) Database (neonates), Virtual PICU Systems (VPS LLC [pediatric intensive care]), and the Extracorporeal Life Support Organization (ELSO) Registry.2-4 Databases need not be focused on a specific patient set or disease entity. The world's largest database of longitudinal medical records exists in the United Kingdom as the General Practice Research Database (GPRD), with more than 5 million active patients in 625 primary care offices.5 The scope of databases in medicine is best represented in the work of Nick Black, with the directory of clinical databases (DoCDat).6 Until the final updates of the DoCDat in December 2010, the directory of clinical databases listed 161 independent clinical databases in the United Kingdom alone.7The most common databases in practice do not have fancy names or acronyms but rather live and work in front of many of us daily. The filing cabinet of monthly billing sheets or a Microsoft Excel spreadsheet tracking staff certifications or fleet maintenance schedules are both databases used regularly in many of transport programs. Although often small-scale, those local databases are built to accomplish focused tasks, and most do that effectively. Microsoft Access and FileMaker Pro are 2 of many platforms for custom databases, with both demonstrating relative ease of use and programmability. Beyond the scope of “homegrown” and custom-built databases are numerous proprietary database and electronic health records specific to EMS and/or the interfacility transport setting.