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 Mobilization Travel/Scene Return with patient 11 minutes 39 minutes 89 minutes

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 PICU secretary Peds senior resident pager Resident on call in PICU Surgical resident Surgical attending PICU attending Ward 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 Lifestar 4Peds secretary PICU secretary Peds senior resident pager Surgical MD to accept Surgical attending PICU attending If needed

Percentage of calls reaching goal (<30 minutes from call to mobilization) Resident training Call routing implemented Call connection center education

Average time (by month) from call to mobilization

Referring hospital Lifestar Peds senior resident pager Surgical MD to accept Surgical attending PICU attending If needed Call to Mobilization: Future Goal for Streamlining

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