Using EHR to Improve Patient Care, Communication Efficiency and Quality in the Transport Environment

Purpose/Objectives: The Lurie Children’s Critical Care Transport Team coordinates transfers for over 5000 patients per year, with 22% (1196) of those being Team Transports. Lurie Children’s transferred to EHR for most hospital departments 15 years ago with the Transport Team remained on paper for phone intake and an Epic smart text note for Team transports. The intake record was scanned into Epic and the smart text noted completed after arrival. Lack of one patient care timeline along with several manual processes were barriers to this workflow. Additionally, the Transport Team manually reviews each chart for GAMUT quality metrics, with quality improvements being difficult to manage due to a laborious process reviewing charts and tracking data.

Design/Methods: After benchmarking with similar hospitals to assess electronic solutions, Epic’s Transfer Center and Transport Narrator were chosen to integrate across the organization. The Transfer Center allows one point of electronic entry for the organization to include not only transfers, but direct admissions to inpatient units the Emergency Department. This coordinated point of entry can generate new medical records, merge records with current patient charts which reduce faxing and calling to coordinate the admissions for all transfers and direct admissions.
The Transport Narrator allows the ability to create one patient care timeline for all care that starts with the critical care transport team and continues throughout the admission. All documentation is recorded in discrete fields which allows for ability to standardize reporting for operational and quality metrics.
A 10+ person team was started in June 2020 to work with Epic and internal analysts. Regular meetings continued to move the project design forward with full Epic implementation of the Transfer Center and Transport Narrator December 8, 2020. Operational and quality metrics design and planning continued at the later stages of the project.

Results: Since implementation, there have been3,000+ intake encounters coordinating transfer for 2700 patients. Iterative improvements to both Epic’s Reporting Work Bench Reports as well as Power BI for Operations and Quality Improvement Metrics. We have also found opportunities for improvement within Epic with multiple small-scale revisions of the work as workflow barriers identified. Metrics are currently being built in Power BI as well as Epic Reporting Work Bench. Early quality improvement efforts have shown we have reduced drip error documentation rate (figure 1).

Conclusion/Discussion: To improve patient care timeline and access to clinical information, the standardization of the transfer center has allowed for immediate access to patient information with less redundancy between clinicians. There is decreased time spent faxing multiple locations, decreased time calling bed planning due to electronic workflow as well as a significant improvement in a standardized processes between departments. This work was supported organizationally with senior leadership support.