Transcript Document

Reducing Mobilization Times on
Pediatric Transports
Pediatric Critical Care
Pediatrics
Loyola LIFESTAR Transport
Time is critical
• The 3R Rule: Get the Right patient to the
Right place at the Right time
– Specialty transport teams reduce mortality and
improve access to specialized care
• Rapid efficient transport of a pediatric
patient to the appropriate level of care
results in improved outcomes
Objective
• Provide timely efficient transfer to tertiary
care at Loyola for pediatric patients at
outside facilities
– Reduce air mobilization times to ≤ 30 minutes
by December 2006
– Reduce ground mobilization times to ≤ 45
minutes by July 2007
Starting Point
• Initiated by Julie Herst Goynshor’s, MD
2006 Senior Resident Project
– Analyzed total transport times
– Delineated stepwise pathway of managing
transport calls
– Presented to Pediatric Department
Pediatric Transport Process
Total: 139 minutes
Call from referring site
Disposition
11 minutes
Mobilization
39 minutes
89 minutes
Travel/Scene
Return with patient
Target Goal
• Measure:
– Time from call to mobilization
– Numerator: # of calls with mobilization time < 30 min
– Denominator: # of transports
• Goal: 30 minutes or less on 95% of calls
• Source of Goal:
– 30 minutes is accepted standard
– Simultaneous requests occur ~ 5% of calls
Before
(50 minutes from call to mobilization)
Referring hospital
Call connection
center
Lifestar
4Peds secretary
Peds senior resident
pager 14075
PICU secretary
Resident on
call in PICU
Surgical resident
Ward attending
PICU attending
Surgical attending
Solutions Implemented
• Remove intermediaries
– Pediatric senior resident triaged all medical calls and
authorized to accept patients
– Surgical services each identified single MD to triage calls
• Improve work flow: Minimize handoffs, parallel tasks
– All calls routed through Lifestar
– Any additional consultations connected through Lifestar
• Education
– PICU attendings trained pediatric senior residents to triage
– Call connection center instructed to route transport calls to
Lifestar
After
(24 minutes from call to mobilization)
Referring hospital
Call connection center
4Peds secretary
PICU secretary
Lifestar
If needed
Surgical attending
Peds senior resident
pager 14075
Surgical MD to accept
PICU attending
Percentage of calls reaching goal
(<30 minutes from call to mobilization)
Call connection
center education
140
120
UCL = 108.59
Resident training
Percent
100
80
60
Mean = 47.44
40
Call routing
implemented
20
0
LCL = 0.00
Confidential Material - for quality improvement purposes only
Average time (by month) from call
to mobilization
100
90
UCL = 85.97
Average Minutes
80
70
60
50
40
Mean = 38.10
30
20
10
0
Confidential Material - For Quality Improvement Purposes Only
Call to Mobilization:
Future Goal for Streamlining
Referring hospital
Lifestar
If needed
Surgical attending
Peds senior resident
pager 14075
Surgical MD to accept
PICU attending
Future goals
• Further steps for improvement
– Calls with mobilization times >30 minutes reviewed by
PICU attendings to identify possible systemic causes
for delay
– Further simplify and accelerate process to accepting
surgical patients
– Provide referring hospitals with single number to
Lifestar for transfer services
– Provide backup system for when senior pediatric
resident unable to respond within 5 minutes
– Set goal for ground transport mobilization to less than
50 minutes