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Reducing Mobilization Times on Pediatric Transports

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

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Reducing Mobilization Times on Pediatric Transports

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  1. Reducing Mobilization Times on Pediatric Transports Pediatric Critical Care Pediatrics Loyola LIFESTAR Transport

  2. 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

  3. 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

  4. 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

  5. Pediatric Transport Process Total: 139 minutes 11 minutes 39 minutes 89 minutes

  6. 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

  7. Referring hospital Call connection center Lifestar 4Peds secretary PICU secretary Peds senior resident pager 14075 Resident on call in PICU Surgical resident PICU attending Ward attending Surgical attending Before(50 minutes from call to mobilization)

  8. 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

  9. After(24 minutes from call to mobilization) Referring hospital Call connection center 4Peds secretary PICU secretary Lifestar If needed Surgical attending Peds senior resident pager 14075 PICU attending Surgical MD to accept

  10. 140 120 UCL = 108.59 100 80 Percent 60 Mean = 47.44 40 20 0 LCL = 0.00 Jul-06 Jun-06 Jan-07 Jan-06 Oct-06 Apr-06 Mar-06 Feb-06 Sep-06 May-06 Aug-06 Nov-06 Dec-06 Confidential Material - for quality improvement purposes only Percentage of calls reaching goal (<30 minutes from call to mobilization) Call connection center education Resident training Call routing implemented

  11. 100 90 UCL = 85.97 80 70 60 Average Minutes 50 40 Mean = 38.10 30 20 10 0 Jul-06 Jun-06 Jan-07 Jan-06 Apr-06 Oct-06 Mar-06 Feb-06 May-06 Aug-06 Dec-06 Sep-06 Nov-06 Confidential Material - For Quality Improvement Purposes Only Average time (by month) from call to mobilization

  12. Call to Mobilization:Future Goal for Streamlining Referring hospital Lifestar If needed Surgical attending Peds senior resident pager 14075 Surgical MD to accept PICU attending

  13. 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

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