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

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Inter-facility transfer context

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Patient safety event review

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Engaging our partners

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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