O1066 Oct.4: 4:35pm - Improving Transport Team Mobilization for Emergent Neonatal Transfers: A Transport-Access Center-Neonatology (TAN) Quality Improvement Initiative

Background: Specialized neonatal transport teams provide efficient, critical care services to the community with decreased mortality and morbidity. During our pre-intervention period, our transport team’s 30-minute mobilization time was met in only <50% of the total emergent neonatal cases admitted.
METHODOLOGY: For this QI initiative, a multidisciplinary team was formed from transport, access center, and neonatology divisions. A project charter following IHI methodology was developed. Our SMART aim was to improve transport team’s mobilization time to ≤30 minutes for >80% of emergent neonatal cases within two years. Transport Mobilization Time (TMT) was our outcome measure, defined as time in minutes from acceptance of an emergent neonatal transfer by our neonatologist to when our transport team departed our hospital. Interventions that were tested during our PDSA cycles were: creation of a communication workflow for all stakeholders, 24/7 availability of two transport teams, participation of transport MD with neonatologist for all intake calls, faster patient room turnovers with more efficient EVS workflow, and keeping a patient room open at all times for anticipated emergent transfers. PDSA cycles were updated as necessary during our monthly reviews of all our neonatal transport cases.

Discussion: During our pre-intervention period (January-March 2018), there was a total of 48 emergent neonatal cases, goal TMT was met in only 27% of the total cases. Intervention periods were divided into phase I (April-December 2018, 191 patients) and phase II (January-December 2019, 216 patients). TMT increased from a baseline (pre-intervention) of 27% to 63% in phase I and 82% in phase II. A 204% improvement rate in our TMT was seen from our pre-intervention to our phase II intervention period.

Conclusion: Our goal TMT for our emergent neonatal transfers was achieved in less than two years through this QI initiative. Factors that impacted our team’s success were: providing clear communication lines for all stakeholders, always maintaining an open critical bed space for a potential emergent neonatal transfer, faster patient room turnovers, adding more transport teams, and involving transport physician with our accepting neonatologist and referring physician at the onset of our neonatal intake calls. The next steps will be sharing our interventions with the other critical care units in the hospital, engaging in a 2-way educational feedback discussion with our community, referring sites, and evaluating our workflow for our non-emergent neonatal transfers.