O1056 Oct.4: 1:20pm - Effect of neonatal transport team structure and activation process revisions on team mobilization time

Background:
While specialized neonatal transport teams are essential to minimize morbidity and mortality, there is no recommended standard configuration: multidisciplinary teams may be unit-based, utilizing team members with concurrent bedside responsibilities, or dedicated, with team members whose sole role is neonatal transport. The complexities of the intake call and team activation processes may also affect transport team deployment. A national consensus statement from the American Academy of Pediatrics section on Transport Medicine suggests including average mobilization time as a standardized measure to monitor transport team quality of care. This quality improvement project evaluated a quaternary care institution’s evolution to a dedicated neonatal transport team and concurrent team activation process revisions by tracking team mobilization time.

SMART

Aim:
To decrease average mobilization time for neonatal transports by 20% from baseline over a six-month period.

PDSA CYCLES:
The local transport database was queried for demographics and time-based process measures for acute ground transports occurring between October 1, 2017, and March 31, 2019. Canceled transports, air transports, transports for ECMO, and scheduled transports (including non-acute transfers for higher level of care, back transports, and short-term transfers for off-site surgeries) were excluded, along with transports with missing or uncertain data (for example, a mobilization time of zero). In May 2018 (PDSA cycle 1), team structure began to transition from unit-based to a dedicated team.

PDSA cycle 2 included process mapping and a multi-day improvement event. Based on key stakeholder feedback suggesting that transport initiation was a lengthy process with multiple entry points, in November 2018 a dedicated transfer phone number was shared with the community and a graphical job aid was circulated, with the goals of streamlining telephone communication between referring providers and medical control physicians and standardizing team activation.

PROCESS/OUTCOMES INDICATORS:
The primary process measure evaluated was average mobilization time.

Results:
A total of 683 transports were included. There was similar distribution of gestational age, chronologic age, patient weights, and diagnoses throughout the study period. During the time of evaluation, average mobilization time decreased from 23 to 18 minutes. Figure 1 illustrates improved process stability and special cause variation.

Discussion:
As an accepted quality metric in critical care transport, decreased average mobilization time reflects an overall improvement in quality of patient care. The impact of individual changes such as team configuration, streamlining of the intake call process, and standardization of team activation is difficult to interpret based on the data timeline.

Limitations of this project include potential data variation associated with changes in data gathering techniques. Ongoing project goals include continued monitoring of mobilization times to evaluate maintenance of improvements and ensure process stability, along with renewed process mapping and investigation into astronomical data points, which may reveal additional opportunities for improvement.