Creating a Pediatric Inter Facility Transfer Team in a Community Hospital. A Multidisciplinary Quality Improvement Initiative.

The trend in regionalization of care has resulted in the mobilization of patients from one healthcare facility to another. Pediatric data in four states, California, Florida, Massachusetts, and New York, showed hospital ability in caring for pediatrics is significantly less than adults resulting in more inter facility transfers for pediatric patients. While federal law, state, and local regulation set specific standards for inter facility transfer, generally, when there is incomplete infrastructure in transferring patients between facilities, increased mortality and length of stay can result. The projects created infrastructure to facilitate a safe and timely transfer for pediatric patients in a community hospital setting. A multidisciplinary workgroup, consist of physicians, nursing, and respiratory therapist managers, put together an initiative to form a pediatric transport team. The project gained approval from hospital administration to utilize the existing pediatric nurse and respiratory therapy staff as the advanced life support (ALS) transport crew. The EMS company agreed to station a fleet in the hospital campus for 12 hours dedicated to pediatric inter facility transfers. The project goal was a 20% reduction in transport time within six months. Transport time defines the time-lapse between patient acceptance and the first vital signs recorded in the electronic health record. Baseline and monthly data were extracted from the hospital and EMS company administrative report. A new workflow was created, emphasized on improving communication between transport team and the accepting team. Safety events were reviewed monthly. The intervention resulted in a 45% (84 min) reduction of transport time as compared to the baseline, with the most considerable reduction in the neonatal intensive care unit measuring 56% follow by the pediatric ward at 44% and the pediatric intensive care unit with a 33% reduction. The infrastructure of pediatric regionalization of care need to include planning for inter facility transfers