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Using a Resource Allocation Decision-Support Tool to Increase Operational Efficiency for a Pediatric Interfacility Transport Team

Sunday, October 21, 2012: 4:10 PM
Room 211-213 (Morial Convention Center)
David J. Mathison, Emergency Medicine, Children's National Medical Center, Washington, DC and Jennifer Schuette, Division of Transport Medicine, Children's National Medical Center, Washington, DC

Background: Resource utilization for pediatric interfacility transport is highly variable among different centers.  It is unclear how best to balance and distribute these resources as teams expand their services from specialized single-unit critical care teams to multi-unit, high-volume comprehensive care teams.

Purpose: This study evaluates the use of an original resource allocation decision-support tool for prioritizing and dispatching interfacility neonatal/pediatric transports.  This tool more explicitly defines the capabilities of different team members and the recommendations for different team configurations and mode of transport based on the specifics of each intake call (figure 1).  The primary outcomes were personnel on transports (team configuration) and mode of transport (ground vs. air), while evaluating for adverse outcomes associated with lower levels of care.  We hypothesized that the use of this tool would increase the number of rotorwing flights and paramedic-only (delta) ground transports.

Methods:   This retrospective analysis compared all interfacility transports to Children's National Medical Center between two four-month periods (Dec 2010—Mar 2011 vs. Dec 2011—Mar 2012).  The resource allocation tool was implemented in November 2011.  This decision-support tool was created based on the local scope of practice for different transport providers and a priority assessment of the timeliness for common diagnoses, created by faculty neonatologists, pediatric emergency and pediatric critical care physicians.  Day level analysis was used to compare the mean number of transports for each team configuration and mode (pediatric and neonatal) during the two time periods.

Results: Similar total transports occurred before (1888) and after (1933) the intervention [N=121 days for each period].  The mean number of paramedic-only (delta) transports per day increased 1700% from 0.24 [+/- 0.53] to 4.26 [+/- 2.41] (p<0.001).  The mean number of paramedic-nurse (charlie) transports per day decreased 30% from 13.41 [+/- 3.36] to 9.31 [+/- 2.97] (p<0.001).  The mean daily use of rotorwing transport increased by 23% from 1.15 [+/- 1.13] to 1.50 [+/- 1.14] (p<.05).  There was a marginal increase in the use of respiratory therapists that was not statistically significant [1.93 +/- 1.34 vs. 2.18 +/- 1.49] (p=0.171).  There were no adverse patient outcomes associated with paramedic-only (delta) transports.  In one case, a paramedic-only unit responded lights-and-sirens because the child was in compensated shock, but no additional interventions would have been performed if more specialized personnel were available.

Conclusion:   Our resource allocation triage/dispatch tool demonstrates a systematic approach for an interfacility team to distribute resources by need rather than by convenience.  If staffing is adjusted accordingly, the team can allocate resources to decrease operational costs and function more efficiently without compromising patient care.

Figure 1 – resource allocation decision-support tool

    

Table 1 – block-level and day-level comparison of transport resource utilization