1. Improving Inter-Facility Transfer Planning for Remote BC Chart of Call Andrew Binette, Manager, Inter-Facility Transfers Ben de Mendonca, Leader, Quality Patient Safety & Accreditation

2. Today A patient journey … Inter-facility transfer context … Patient safety event review … Engaging our partners … The solution

3. Meet Karen 82 Grandmother Dease Lake

4. Meet Karen Chronic Renal Failure Septic #Hip

5. Dease Lake Terrace Prince George Watson Lake Kamloops You are here

6. The Event Reported to Quality and Patient Safety as a patient safety event. Potential harm due to delay in intervention Concerns presented by the sending facility –“This is every transfer” –“We tell people to drive themselves to Watson Lake” –“The citizens of Dease Lake are under serviced”

7. Inter-Facility Transfers PTCC call volume –250 M-F and 150 S&S –~90,920 / year Mode of transport –5 fixed wing aircrafts –4 helicopters –Ambulances –Boats Medical crews –Basic Life Support –Advanced Life Support –Critical Care Paramedics –Infant Transport Team

8. Inter-Facility Transfers BCPTN Triage and Prioritization –Red/Yellow/Green/Blue One Number to Call Clinical Oversight

9. Our Response Event Review Process Patient safety event review process

10. Recommendation Develop a standard decision tool for the PTCC Critical Care Coordinators to use when planning transfers from Dease Lake. Standardize workflow Collaborate

11. The Solution Chart of Call Quality Improvement Initiative PDSA methodology Data – patient safety events and access to care Our Partners:

12. Quality Improvement Project

13. PDSA

14. Chart of Call

16. Dispatch to Arrived at Hospital Calendar Year 2013 Transfer Time Data Total25 Ground5 Air20 MeanMedian75th95th 6:43:324:49:597:29:2720:37:47 DP – AR 5:28:533:34:526:06:3619:19:28 TR – AR Calendar Year 2014 Transfer Time Data Total23 Ground8 Air15 MeanMedian75th95th 5:26:264:05:117:17:3510:44:12 4:21:213:10:215:08:4510:33:14 19%15%3%48%

17. Initial Call to PTN to Patient Arrived at Hospital MeanMedian 75 th Percentile 95 th Percentile 13:02:2810:26:1514:43:4830:51:192013 11:01:368:52:4210:39:4020:44:182014 15% 28%33%

18. Chart of Call Since our intervention… Access to care eliminated outliners # Patient Safety Events went from 5 to 0. December 2014 “We just had a medevac that went like clockwork. The patient was an organ at risk patient admitted at 12:08 and gone at 13:35. This just proves that it can be done!” RNBN, Northern Health, Dease Lake

19. This is why it matters