Improving Inter-Facility Transfer Planning for Remote BC
Chart of Call
Andrew Binette, Manager,
Inter-Facility Transfers
Ben de Mendonca, Leader, Quality Patient Safety & Accreditation
TodayA patient journey
…
Inter-facility transfer context
…
Patient safety event review
…
Engaging our partners
…
The solution
Meet Karen
82GrandmotherDease Lake
Meet Karen
Chronic Renal Failure
Septic
#Hip
Dease Lake
Terrace
Prince G
eorge
Watson Lake
Kamlo
ops
You are here
The Event
• Reported to Quality and Patient Safety as a patient safety event.
• Potential harm due to delay in intervention• Concerns presented by the sending facility
– “This is every transfer”– “We tell people to drive themselves to Watson
Lake”– “The citizens of Dease Lake are under
serviced”
Inter-Facility Transfers• PTCC call volume
– 250 M-F and 150 S&S – ~90,920 / year
• Mode of transport– 5 fixed wing aircrafts– 4 helicopters – Ambulances – Boats
• Medical crews– Basic Life Support– Advanced Life Support– Critical Care Paramedics– Infant Transport Team
Inter-Facility Transfers
• BCPTN Triage and Prioritization– Red/Yellow/Green/Blue
• One Number to Call
• Clinical Oversight
Our Response Event Review Process
• Patient safety event review process
Recommendation
• Develop a standard decision tool for the PTCC Critical Care Coordinators to use when planning transfers from Dease Lake.
• Standardize workflow
• Collaborate
The Solution
• Chart of Call• Quality Improvement Initiative• PDSA methodology• Data – patient safety events and access to
care• Our Partners:
Quality Improvement Project
Background: PTCC and PTN work together to ensure BCEHS provides interfacility transfers for patients within BC. BCEHS Operations are challenged with environmental and geographical constraints to providing interfacility transfers on demand. A patient safety event review highlighted the specific challenges of Dease Lake for a higher level of care transfer requiring air ambulance resources. This project is scoped to assist in the implementation of recommendations out of the Dease Lake review.
Current State: PTN intakes interfacility transfer requests, identifies an appropriate facility to transfer the patient, triages the priority of the call and hands off to PTCC. PTCC is in charge of logistical planning for the transfer request. PTCC has an online Library of facility information and transfer considerations.
Problem Statement: Demand for interfacility transfers out of Stikine Health Centre in Dease Lake is low compared to similar communities in BC. The infrequency of transfers and location of Dease Lake creates complexities when scheduling the logistics of the transfer.
Project Objective: 1. Develop a Chart of Call for transfers out of Dease Lake. 2. Develop a template for other complex remote locations. 3. Update the online library for PTCC to aid in decision making when planning the
logistics of a transfer out of Dease Lake. Project Timeline: 1. Review the transfer demand for Dease Lake: Baseline Complete 2. Development of draft chart of call plan for Dease Lake: 2014-06-13 3. Development an information relay standard during an escalation process for PTCC:
2014-06-27 4. Implementation of chart of call for Dease Lake in PTCC procedure manual:
2014-07-04 5. Evaluate the project: 2014-09-26
Deliverables: 1. Chart of call for interfacility transfers in Dease Lake. 2. Develop a Chart of Call template for decision 3. Information relay document for PTCC to Critical Care Manager on call 4. Quantify interfacility demand for all remote health centre locations in the
province.
Expected Costs: No Cost
Expected Results: Develop a standardized approach to transfer planning out of Dease Lake Reduction in response time to transfer planning out of Dease Lake Increased communication between PTN, PTCC and Stikine Health Centre
Sustainment Plan: Integration of operational planning and oversight of CCT Program and PTCC of high acuity interfacility transfers Establish a decision support framework using interfacility demand data Ongoing PDSA cycles of adapting the chart of call process Evaluation and feedback to the project team
Sponsors Signature:
Date:
Process Owner Signature:
Date:
PDSA
Chart of Call
Chart of Call
Dispatch to Arrived at HospitalCalendar Year 2013 Transfer Time Data
Total 25 Ground 5 Air 20
Mean Median 75th 95th 6:43:32 4:49:59 7:29:27 20:37:47 DP – AR 5:28:53 3:34:52 6:06:36 19:19:28 TR – AR
Calendar Year 2014 Transfer Time DataTotal 23 Ground 8
Air 15Mean Median 75th 95th
5:26:26 4:05:11 7:17:35 10:44:12 4:21:21 3:10:21 5:08:45 10:33:1419% 15% 3% 48%
Initial Call to PTN to Patient Arrived at Hospital
Mean Median75th
Percentile 95th
Percentile
13:02:28 10:26:15 14:43:48 30:51:19 2013
11:01:36 8:52:42 10:39:40 20:44:18 2014
15% 15% 28% 33%
Chart of Call
• Since our intervention…Access to care eliminated outliners
# Patient Safety Events went from 5 to 0.
December 2014
“We just had a medevac that went like clockwork. The patient was an organ at risk patient admitted at 12:08 and gone at 13:35.This just proves that it can be done!”
RNBN, Northern Health, Dease Lake
This is why it matters