On the basis of data Collection of life saving patient transfer to higher center, we found that about 53.19% of patient were transferred more than one hour and sometimes reached to 7 hours and more. The delaying in transfer will decrease the prognosis of life threatening cases and patients' relatives always complaining and unsatisfied from the patient transfer management. Flow chart for life saving transfer process YES Patient came in ER in critical condition Patient came in ER in critical condition Accepted to transfer YES Patient shifted to another hospital on time without delay Arrange doctor/nurse anesthesia technician Prepare the ambulance (checking ambulance for ventilator, O2, pulse oximeter,and other medication prepare patient for transfer ( investigation s, X-Rs, CTS, U /S, police clearance, medical report prepare patient for transfer ( investigation s, X-Rs, CTS, U /S, police clearance, medical report Fax reply for patient acceptance Fax and medical report Send fax and medical report to emergency coordination Need transfer to higher center Patient revived Needs CPR Assessment by treating physician At least 30 minutes CPR Human Human Machine Material Environment Method Ambulance Driver Not available Nurse delaying in attendance Doctor Delaying in attendance Patients' relative Not Available Anesthesia Technician: Delay in attendance Ambulance Driver Not available Nurse delaying in attendance Doctor Delaying in attendance Patients' relative Not Available Anesthesia Technician: Delay in attendance Ventilator No portable ventilator available Pulse Oximeter No battery Oxygen Cylinder No enough O2 cylinder O2 is not full Ambulance Supplies are not enough Ventilator No portable ventilator available Pulse Oximeter No battery Oxygen Cylinder No enough O2 cylinder O2 is not full Ambulance Supplies are not enough X-rays, CT,U/S Unavailable report Police Clearance Paper not available Patients' I.D Not available Investigation reports Not available X-rays, CT,U/S Unavailable report Police Clearance Paper not available Patients' I.D Not available Investigation reports Not available  Off duty hours so difficulty In communication all related people  Very crowded after duty hours with patient relative  Due to shortage to find escort specially nurses & very difficult to find doctors  Increase number of transfer due to increase number of RTA  Off duty hours so difficulty In communication all related people  Very crowded after duty hours with patient relative  Due to shortage to find escort specially nurses & very difficult to find doctors  Increase number of transfer due to increase number of RTA Policy Policy and procedure not communicating well Policy Policy and procedure not communicating well Delayed Life Saving Patient Transfer to Higher Center ActivityResponsibilityTarget DateResourceOutcome 1.Write clear policy for patient transfer Outside the hospital.  Nursing administration  Quality Coordinator One month ( ) Policy approved from Hospital Director Smooth work process will develop 2.Write a clear policy for ambulance checking  Nursing administration  Quality Coordinator One month from ( ) Policy approved from Hospital Director  Improve teamwork.  Smooth work process.  Ambulance will be ready from mechanical and electrical side and also from biomedical and nursing side.  patient will transfer on time. 3. Make schedule for escort nurses, physicians, anesthesia technician.  Nursing administration  Medical director One month From ( ) Written escort team schedule & Approved from hospital director  Prevent delayed physician and escort nurse. 4.Request enough portable ventilators & O2 cylinders  Nursing Director One month From ( ) Written request to hospital administration It will prevent delaying patient transfer because machines and materials will be available. 5.Conduct educational session to all staff nurses about how to operate the ambulance & machines  Nursing educator  Biomedical engineer One month From ( ) -Ambulances - Medical equipments and machines Easy operation of the ambulance and medical equipments will decrease delaying patient transfer. 6- Separate special drivers to be responsible to escort the ambulance only and free from other work  Hospital administration  Chief of drivers One month From ( ) Witten request and approved by hospital administration -The driver will be always available. -Patient will transfer on time and will not be delayed. AVERAGE TIME NEEDED TO TRASFER THE PATIENT IN THE YEAR 1433 ( FROM MONTH 4 – 12 ) AVERAGE TIME NEEDED TO TRASFER THE PATIENT IN THE YEAR 1434 TRENDING REPORT OF IMPROVE TIME OF LIFE SAVING PATIENT TRANSFER FOR THE YEAR 1433 & 1434 Pareto Chart (Reason Of Delaying Life Saving Patient Transfer) Year 1434 & 1435 PROVE TIME OF LIFE SAVING PATIENT TRANSFER 1435 (MONTH 1-5 ) CURRENT ACTIONS:  Achieve 72.2 % of life saving patients transferred to higher center within one hour.  Immediate response from the escort team.  24 hours ambulances, emergency kit, medical equipments are available & ready.  Approved escort schedule for nurses & still physician to follow  Avoid writing live saving fax before stabilization of the patient and fax should be written after all necessary procedures done  Request the police station clearance for patient transfer to other hospitals in all RTA cases upon admission.  24 Hours drivers are covering duty. FUTURE PLAN:  Continue the implementation of strategic action plan and monitoring till we will reach to all critical patients transferred within one hour  Requesting enough staff.  continue implementation of patient transfer policy FUTURE PLAN:  Continue the implementation of strategic action plan and monitoring till we will reach to all critical patients transferred within one hour  Requesting enough staff.  continue implementation of patient transfer policy No AVERAGE TIME NEEDED TO TRASFER THE PATIENT IN THE YEAR 1435 (MONTH 1-11) Decreased time to transfer of critically ill patients Increased Prognosis