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Identifying causes of delay in interfacility transfer of patients by air ambulance

Published online by Cambridge University Press:  21 October 2020

Alanna Wong
Affiliation:
University of Toronto, Department of Medicine Toronto, ON
Aidan McParland
Affiliation:
University of Toronto, Department of Medicine Toronto, ON
Brodie Nolan
Affiliation:
St. Michael's Hospital, Toronto, ON Ornge, Mississauga, ON
Corresponding
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Abstract

Objectives

Population density can limit the level of care that can be provided in local facilities in Ontario, and as such, patients with severe illnesses often require interfacility transfers to access specialized care. This study aimed to identify causes of delay in interfacility transport by air ambulance in Ontario.

Methods

Causes of delay were identified by manual review of electronic patient care records (ePCRs). All emergent interfacility transfers conducted by Ornge, the sole provider of air-based medical transport in Ontario, between January 1, 2016 and December 31, 2016 were included. The ePCRs were reviewed if they met one or more of the following: (1) contained a standardized delay code; (2) contained free text including “delay”, “wait”, or “duty-out”; (3) were above the 75th percentile in total transport time; or (4) were above the 90th percentile in time to bedside, time at the sending hospital, or time to receiving facility.

Results

Our search strategy identified 1,220 ePCRs for manual review, which identified a total of 872 delays. Common delays cited included aircraft refueling (234 delays), waiting for land emergency medical service (EMS) escort (146), and staffing- or dispatch-related issues (124). Other delays included weather/environmental hazards (43); mechanical issues (36); and procedures, imaging, or stabilization (80).

Conclusions

Some common causes of interfacility delay are potentially modifiable: better trip planning around refueling and improved coordination with local EMS, could reduce delays experienced during interfacility trips. To better understand causes of delay, we would benefit from improved documentation and record availability which limited the results in this study.

Résumé

Résumé Objectif

La faible densité de la population peut limiter le niveau de prestation de soins dans les établissements locaux en Ontario et, de ce fait, les patients gravement malades ont souvent besoin d’être transportés dans d'autres établissements pour recevoir des soins spécialisés. L’étude visait donc à cerner les causes de retard dans les transports de patients, entre établissements, par ambulance aérienne, dans la province.

Méthode

C'est par un examen manuel des dossiers médicaux électroniques qu'ont été relevées les causes de retard. Tous les transports urgents de malades entre établissements, effectués par Ornge, le seul fournisseur de transport médical aérien en Ontario, entre le 1er janvier et le 31 décembre 2016, ont été inclus dans l'analyse. Étaient soumis à l'examen les dossiers satisfaisant à au moins l'un des critères suivants : 1) la présence d'un code normalisé de retard; 2) la mention des mots « retard », « attente » ou « congé après l'atteinte du nombre maximal d'heures de travail » dans du texte libre; 3) la durée totale de transport au-dessus du 75e centile; ou 4) le temps écoulé avant l'arrivée à l'hôpital, le temps passé à l'hôpital ou le temps écoulé avant l'arrivée à l’établissement d'accueil au-dessus du 90e centile.

Résultats

La méthode de recherche a conduit à l'examen manuel de 1220 dossiers et permis de dénombrer 872 retards. Les principales causes de retard comprenaient l'avitaillement en carburant des aéronefs (234 retards), l'attente des équipes terrestres de soins médicaux d'urgence (SMU) (146) et les problèmes de personnel ou de répartition (124). Quant aux autres causes de retard figuraient le mauvais temps ou des risques environnementaux (43), des ennuis mécaniques (36) ainsi que des interventions, des examens par imagerie ou la stabilisation de l’état des malades (80).

Conclusions

Certaines causes courantes de retard dans les transports entre établissements sont susceptibles de correction; ainsi, une meilleure planification de l'avitaillement en carburant et une meilleure coordination avec les SMU locaux permettraient de réduire les retards éprouvés durant les transports entre établissements. Enfin, pour mieux comprendre les causes de retard, il faudrait améliorer la qualité de la documentation et détailler davantage les dossiers; leur faiblesse à cet égard a limité la portée des résultats de l’étude.

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

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