O2104: Increasing Pediatric Interhospital Transport Efficiency: A Quality Improvement Intervention

Purpose/Objectives: Johns Hopkins Pediatric Transport (JHPT) coordinates all incoming pediatric transfers to our quaternary center and utilizes a dynamic staffing model. With our recent growth in transport volume, our staffing model of one pediatric transport nurse – who also served as the intake nurse (iRN) – could result in delays and inefficiencies in transport. Therefore, JHPT implemented a change in its transfer intake process by developing a dedicated iRN role, staffed by a pediatric transport nurse not providing direct patient care. The iRN’s responsibilities include: 1) triaging transfer referral calls; 2) communicating with sending and receiving providers; and 3) coordinating the entire transport process from dispatch to patient retrieval. We hypothesized that this quality improvement effort would increase transport process efficiency, reliability, and consistency, potentially leading to improved patient outcomes.

Design/Methods: We performed a retrospective review of patients aged ≤21 years transferred to our children’s center three months pre-intervention (5/1/2021-7/31/2021) and three months post-intervention (8/1/2021-10/31/2021). We then compared pre- and post-intervention times to answer the referral call, accept the patient, and mobilize the team.

Results: We reviewed 1,402 charts with available transport information: 646 in the pre-intervention and 756 in the post-intervention group. The Table details patient characteristics and transport times. While the times to answer the referral call and accept the patient were not different between groups, the post-intervention group had slightly longer transport mobilization time. There was a similar trend for the critical care transport (CCT) subgroups, with no differences in time to answer the call (median [IQR]: 3 [2-7] vs. 4 [3-6.3] minutes) and acceptance time (13 [6-33] vs. 10 [5-24] minutes), but a longer post-intervention mobilization time (52 [27-116.7] vs. 39 [24-71] minutes). Notably, 137/238 (57.6%) post-intervention CCTs were dispatched within 60 minutes from the referral call, compared to 123/175 (70.3%) pre-intervention CCTs. Compared to the pre-intervention group, the post-intervention group had 17% higher call volume and 36.6% increase in CCTs, more days with ≥90% intensive care unit (ICU) occupancy rates (90% vs. 74%), and more patients unable to be accommodated due to lack of hospital capacity (113 vs. 41). These trends are displayed in the Figure. There were 68 CCTs performed on days with < 90% ICU occupancy: 25 post-intervention (2.8 CCTs/day) vs. 43 pre-intervention (1.8 CCTs/day). For this subgroup, the average daily acceptance time was significantly shorter post-intervention (median [IQR]: 8.6 [5.6-13.6] vs. 17.7 [8.3-36.5] minutes); however, mobilization time remained longer (60.5 [39-73] vs. 38.5 [26-55.7] minutes), likely due to increased CCT volume.

Conclusion/Discussion: While transport times did not decrease post-intervention, we believe this was largely due to the unanticipated surge in pediatric critical care transports, compounded by historic ICU capacity challenges. Acceptance time reflected the extremely low ICU capacity, while mobilization time mirrored the increased transport volume.