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Rajapreyar P, Badertscher N, Willie C, Hermon S, Steward B, Meyer MT. Improving Mobilization Times of a Specialized Neonatal and Pediatric Critical Care Transport Team. Air Med J 2022; 41:315-319. [PMID: 35595341 DOI: 10.1016/j.amj.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 12/05/2021] [Accepted: 01/07/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The Ground and Air Medical Quality Transport database identifies the average mobilization time (AMT) of the transport team as a metric for benchmarking. Our specific aim was to decrease our AMT to < 25 minutes for our expanded role, ground, nonsimultaneous transports by the end of quarter 4 of 2018. METHODS Standardization of data collection with awareness building, ambulance vendor involvement, and team-focused interventions were the different phases of project implementation. Documentation of reasons for delay was performed pre- and postimplementation. RESULTS Our AMT decreased from a baseline of 30.3 minutes to 24.5 minutes after project implementation. Communication delays (19.0%), reason for delay not documented (16.5%), no team available (14.0%), rotor wing vendor delays (12.4%), and ambulance vendor delays (7.4%) were the common reasons for delay on our preimplementation Pareto analysis. Communication and pharmacy delays were the most common reasons during all 3 phases of our project. CONCLUSIONS Implementation of the project allowed us to achieve our goal of improving our AMT. Understanding the reasons for delay is a crucial consideration, and success depends on careful change management. Further iterations will need to focus on improving communication and the pharmacy medication dispatch process.
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Affiliation(s)
- Prakadeshwari Rajapreyar
- Department of Pediatric Critical Care, Medical College of Wisconsin, Milwaukee, WI; Children's Wisconsin, Milwaukee, WI.
| | | | | | - Sunita Hermon
- Department of Pediatric Critical Care, Medical College of Wisconsin, Milwaukee, WI; Children's Wisconsin, Milwaukee, WI
| | | | - Michael T Meyer
- Department of Pediatric Critical Care, Medical College of Wisconsin, Milwaukee, WI; Children's Wisconsin, Milwaukee, WI
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Garrido Conde B, Millán García del Real N, Esclapés Giménez T, Marsinyach Ros I, Toledo Parreño JD, Núñez Cárdenas MDM, Domínguez Sampedro P, Brandstrup Azuero KB. Desarrollo de un sistema de indicadores para la evaluación de la calidad en transporte interhospitalario: proyecto multicéntrico. An Pediatr (Barc) 2021. [DOI: 10.1016/j.anpedi.2020.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Garrido Conde B, Millán García Del Real N, Escaplés Giménez T, Marsinyach Ros I, Toledo Parreño JD, Nuñez Cárdenas MDM, Domínguez Sampedro P, Brandstrup Azuero KB. Quality indicators in interhospital transport: Multicentre project. An Pediatr (Barc) 2021; 95:167-173. [PMID: 34353776 DOI: 10.1016/j.anpede.2020.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/10/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Interhospital transport is carried out by variable teams in different regions of our country, and this makes quality evaluation and benchmarking complicated. Project objective: Select and define a consensual list of quality measurement that may be used by national transport units, whether specialised or not. METHODS Initial set of quality indicators was proposed by coordinators (members of representative specialised transport units in Spain). Evaluation by selected transport specialists from participating units and SECIP (Society of Paediatric Intensive Care) and SENeo (Spanish Neonatology Society) work teams. Selection of definitive indicators by Delphi method according to relevance and feasibility. RESULTS A total of 35 quality indicators were included in the initial set. Evaluation was carried out by 22 specialists from 7 transport teams. In a first round, 4 indicators were consensually included in the definitive list. Results for the rest of metrics and comments were sent to all participants, and after a second assessment, 11 other indicators reached enough consensus. After list accomplishment, a consensual final definition for every indicator was established. CONCLUSIONS Using a consensual research method, a list of 15 common indicators was obtained, which may be used by specialised transport teams in our country, and by non-specialised clinics in charge of interhospital paediatric transport. It will allow individual performance to be assessed, as well as benchmarking, in order to find improvement opportunities and ensure the highest quality during interhospital transport.
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Affiliation(s)
- Beatriz Garrido Conde
- Unidad de Transporte Pediátrico Balear, Hospital Son Espases. Palma, Mallorca, Spain.
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Edwards KH, FitzGerald G, Franklin RC, Edwards MT. Air ambulance outcome measures using Institutes of Medicine and Donabedian quality frameworks: protocol for a systematic scoping review. Syst Rev 2020; 9:72. [PMID: 32241304 PMCID: PMC7118977 DOI: 10.1186/s13643-020-01316-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/01/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Dedicated air ambulance services provide a vital link for critically ill and injured patients to higher levels of care. The recent developments of pre-hospital and retrieval medicine create an opportunity for air ambulance providers and policy-makers to utilize a dashboard of quality performance measures to assess service performance. The objective of this scoping systematic review will be to identify and evaluate the range of air ambulance outcome measures reported in the literature and help to construct a quality dashboard based on a healthcare quality framework. METHODS We will search PubMed, MEDLINE, CINAHL, Scopus, and Cochrane Database of Systematic Reviews (from January 2001 onwards). Complementary searches will be conducted in selected relevant journals. We will include systematic reviews and observational studies (cohort, cross-sectional, interrupted time series) in critically ill or injured patients published in English and focusing on air ambulance delivery and quality measures. Two reviewers will independently screen all citations, full-text articles, and abstract data. The study methodological quality (or bias) will be appraised using appropriate tools. Analysis of the characteristics associated with outcome measure will be mapped and described according to the proposed healthcare quality framework. DISCUSSION This review will contribute to the development of an air ambulance quality dashboard designed to combine multiple quality frameworks. Our findings will provide a basis for helping decision-making in health planning and policy. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019144652.
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Affiliation(s)
- Kristin H Edwards
- College of Public Health, Medical and Veterinary Sciences, James Cook University, 1 James Cook Drive, Townsville, Queensland, Australia.
| | - Gerard FitzGerald
- Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, Queensland, Australia
| | - Richard C Franklin
- College of Public Health, Medical and Veterinary Sciences, James Cook University, 1 James Cook Drive, Townsville, Queensland, Australia
| | - Mark Terrell Edwards
- College of Public Health, Medical and Veterinary Sciences, James Cook University, 1 James Cook Drive, Townsville, Queensland, Australia
- LifeFlight Retrieval Medicine Australia, Edward Street, Brisbane, Queensland, Australia
- Queensland Health, Emergency Medicine Department Rockhampton, Rockhampton Base Hospital, Canning Street, Rockhampton, Queensland, Australia
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Colyer E, Sorensen M, Wiggins S, Struwe L. The Effect of Team Configuration on the Incidence of Adverse Events in Pediatric Critical Care Transport. Air Med J 2018; 37:186-198. [PMID: 29735232 DOI: 10.1016/j.amj.2018.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 02/20/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Specialty pediatric transport teams are widely used for pediatric interfacility transport in the United States, with little industry consensus on optimal team configuration. The aim of this study is to assess the quality of the nurse/paramedic specialty team configuration as indirectly measured by the rate of adverse events in these transports. METHODS Retrospective analysis of pediatric transport data from a hospital-based dedicated pediatric/neonatal transport team was conducted for patients transported in 2016. Data were categorized by general characteristics of transport and analyzed for the occurrence of adverse events. RESULTS Five hundred sixty-four cases were analyzed. Cases were described by team configuration and then by transport mode, duration, time, patient age and acuity, and disposition. The overall rate of adverse event incidence was 8.3%, chiefly centered in device and process domains. There was no significant difference in the rate of adverse events between team configurations. CONCLUSION There was no significant difference in the rate of adverse event occurrence in nurse/paramedic team configurations versus nurse/nurse configuration. Using critical care paramedics on pediatric transport teams enables a larger volume of patients to be transported to definitive care without concerns for decrease in quality or safety.
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Affiliation(s)
- Emily Colyer
- Pediatric/Neonatal Critical Care Transport Team, Children's Hospital & Medical Center, Omaha, NE.
| | - Megan Sorensen
- Pediatric/Neonatal Critical Care Transport Team, Children's Hospital & Medical Center, Omaha, NE
| | - Shirley Wiggins
- College of Nursing, University of Nebraska Medical Center, Lincoln, NE
| | - Leeza Struwe
- College of Nursing, University of Nebraska Medical Center, Lincoln, NE; Niedfelt Nursing Research Center, University of Nebraska Medical Center, Lincoln, NE
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Krennerich E, Sitler CG, Shah M, Lam F, Graf J. Retrospective Review of Pediatric Transport: Where Do Our Patients Go After Transport? Air Med J 2017; 36:332-338. [PMID: 29132597 DOI: 10.1016/j.amj.2017.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/04/2017] [Accepted: 06/29/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This review describes disposition of transported children and identifies contributing factors affecting optimal patient placement. The study describes timing and patient placement indicators in transport patients to identify areas of improvement, re-education, and training. METHODS A retrospective chart review for transports via our pediatric specialty transport team from January 1, 2012, to December 31, 2014, was performed. Patients were identified by the transport quality assurance performance improvement database, hospital electronic medical records, and transport medical records. RESULTS Three thousand two hundred fifty-six pediatric patient transports were reviewed. One hundred forty-three records were excluded. Of the remaining 3,113 patients, admission disposition was: 1,487 (47%) pediatric intensive care unit, 120 (4%) pediatric cardiovascular intensive care unit, 835 (27%) step-down critical care unit, 438 (14%) emergency department, 194 (6%) general floor, 29 (1%) neonatal intensive care unit, and 10 (< 1%) operating room. Of the 22% transported to a lower-acuity unit, several subsequently required critical care. Children transported for traumatic injuries had a shorter emergency department length of stay than medical patients. CONCLUSION Our study validates the efficient use of pediatric specialty transport team resources. Many transported patients are critically ill, require specialized pediatric services, or require definitive pediatric emergency department care.
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Affiliation(s)
- Emily Krennerich
- Department of Pediatric Critical Care, Texas Children's Hospital, Houston, TX; Baylor College of Medicine, Houston, TX.
| | - Curtis G Sitler
- Department of Pediatric Critical Care, Texas Children's Hospital, Houston, TX
| | - Manish Shah
- Baylor College of Medicine, Houston, TX; Department of Pediatric Emergency Medicine, Texas Children's Hospital, Houston, TX
| | - Fong Lam
- Department of Pediatric Critical Care, Texas Children's Hospital, Houston, TX; Baylor College of Medicine, Houston, TX
| | - Jeanine Graf
- Department of Pediatric Critical Care, Texas Children's Hospital, Houston, TX; Baylor College of Medicine, Houston, TX
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Whyte HEA, Jefferies AL. The interfacility transport of critically ill newborns. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.265] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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