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