Reducing Mobilization Times on Reducing Mobilization Times on Pediatric TransportsPediatric Transports
Pediatric Critical CarePediatric Critical CarePediatricsPediatrics
Loyola LIFESTAR TransportLoyola 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 ProcessTotal: 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 14075
Resident on call in PICU
Surgical resident
Surgical attendingPICU attendingWard 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 secretaryPICU secretary
Peds senior resident pager 14075
Surgical MD to accept
Surgical attending
PICU attending
If needed
Percentage of calls reaching goal (<30 minutes from call to mobilization)
Confidential Material - for quality improvement purposes onlyJa
n-06
Feb-06
Mar-06
Apr-06
May-06
Jun-0
6Ju
l-06
Aug-06
Sep-06
Oct-06
Nov-06
Dec-06
Jan-0
7
0
20
40
60
80
100
120
140
UCL = 108.59
Mean = 47.44
LCL = 0.00
Per
cent
Resident training
Call routing implemented
Call connection center education
Average time (by month) from call to mobilization
Confidential Material - For Quality Improvement Purposes OnlyJa
n-06
Feb-06
Mar-06
Apr-06
May-06
Jun-0
6Ju
l-06
Aug-06
Sep-06
Oct-06
Nov-06
Dec-06
Jan-0
70
10
20
30
40
50
60
70
80
90
100
UCL = 85.97
Mean = 38.10
Ave
rage
Min
utes
Referring hospital
Lifestar
Peds senior resident pager 14075 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