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Factors associated with non-optimal resource utilization of air ambulance for interfacility transfer of injured patients

Published online by Cambridge University Press:  21 October 2020

Andrew Quirion
Affiliation:
Department of Medicine, University of Toronto, Toronto ON
Mahvareh Ahghari
Affiliation:
Ornge, Toronto ON
Brodie Nolan
Affiliation:
Ornge, Toronto ON Department of Medicine, St. Michael's Hospital, Toronto ON
Corresponding
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Abstract

Objective

Timely access to definitive care is associated with improved outcomes in trauma patients. The goal of this study is to identify patient, institutional and paramedic risk factors for non-optimal resource utilization for interfacility transfers of injured adult patients transported by air ambulance to a LTC.

Methods

This is a retrospective cohort study of adult emergent interfacility transports via Ornge with data collected on patient demographics, clinical status, sending facilities, transport details and paramedic qualifications. A logistic regression model was used to analyze data.

Results

1777 injured patients undergoing transport with Ornge were analyzed with 805 of these undergoing non-optimal transport. Patients who had an optimal resource use were found to be older and mechanically ventilated. Risk factors increasing odds of non-optimal transport included patients transported from a nursing station (OR 1.94), transport with primary or advanced care paramedics (OR 6.57 and 1.44, respectively) and transport between both 0800-1700 and 1700-0000 (OR 1.40 and 1.54, respectively). The median delay to arrival to receiving facility if a patient had a non-optimal resource use was 40 minutes.

Conclusions

Three main risk factors were identified in this study. We believe that nursing stations as a sending facility and type of paramedics crew transporting patients resulted in non-optimal resource utilization primarily due to triage of lower acuity patients. However the timing of day is more likely to be a resource availability issue and something that can be further studied and potentially improved moving forward.

Résumé

Résumé Objectif

L'accès rapide à un traitement indiqué est associé à une amélioration des résultats chez les blessés. L’étude avait donc pour but de cerner des facteurs de risque d'utilisation non optimale des ressources, liés aux patients, aux établissements et aux ambulanciers paramédicaux, dans les mutations de blessés adultes, entre établissements, par ambulance aérienne, vers un centre de soins.

Méthode

Il s'agit d'une étude de cohortes, rétrospective, menée chez des adultes transportés de toute urgence vers un autre établissement, par Ornge. Ont été recueillis des données démographiques ainsi que des renseignements sur l’état clinique, l’établissement d'origine, le transport et les compétences des ambulanciers paramédicaux. Il y a eu analyse des données à l'aide d'un modèle de régression logistique.

Résultats

Sur 1777 transports de blessés par Ornge, 805 étaient considérés comme non optimaux, d'après l'analyse des données. Ceux chez qui le transport était jugé optimal étaient plus âgés que les autres et sous ventilation mécanique. Les facteurs de risque de transport non optimal comprenaient les mutations de patients depuis des postes de soins infirmiers (risque relatif approché [RRA] : 1,94), celles effectuées en présence de paramédicaux en soins primaires ou en soins avancés (RRA : 6,57 et 1,44, respectivement) et celles effectuées entre 8:00 et 17:00 et entre 17:00 et 00:00 (RRA : 1,40 et 1,54, respectivement). Le retard médian avant l'arrivée à l’établissement d'accueil, dans les cas d'utilisation non optimale des ressources, était de 40 minutes.

Conclusion

Il s'est dégagé de l’étude trois grands facteurs de risque. Les auteurs sont d'avis que les postes de premiers soins comme établissements de départ et le type d’équipe d'ambulanciers paramédicaux présents durant les transports entraînent une utilisation non optimale des ressources, en raison surtout du faible degré de gravité au moment du triage. Toutefois, le moment de la journée pose davantage un problème de disponibilité des ressources, point qui mériterait d’être approfondi et qui serait susceptible d'amélioration au fil du temps.

Type
ORNGE Supplement
Copyright
Copyright © Canadian Association of Emergency Physicians 2020

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