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Just Say Yes!
A Plan & Process for Rapid Transfer Out
Alexandra Evans, RN BSN
Lehigh Valley Hospital- Hazleton
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Relationship Advice 101
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Question
■ Does a rural ER provider NEED to speak with the on-call attending
Trauma Surgeon at a Level I/II Trauma Center for the transfer of a critical
patient?
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Identification of Major Barriers
■ CT Throughput
■ Delayed Decision times
■ Lack of physical transport
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What is a trauma patient?
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CT Throughput: Possible Barriers
■ CT availability
■ Radiology tech availability?
■ CT process
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CT Throughput: Opportunities
■ Set GOALS!!!
– Time to CT
– Priority Imaging
■ Special Considerations
– Pediatric/Geriatric
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Door to CT ≤ 30 Minutes:
Trauma Alerts (Highest Level)
67%
45%
75%
56%50% 50%60%
86%
33%
100%
64%
100%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Sep'17
Oct Nov Dec Jan'18
Feb Mar Apr May Jun Jul Aug
PTOS & NPTOS
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Door to CT Time:
Tier II Activations
24%
39%
62%
46%38% 34%
40%53% 48% 51%
59% 59%
80% 82%96%
80% 78% 79% 83% 81% 84% 86% 86% 86%
0%
20%
40%
60%
80%
100%
Sep'17
Oct Nov Dec Jan'18
Feb Mar Apr May Jun Jul Aug
PTOS & NPTOS
% Tier II ≤ 30 Min % Tier II ≤ 60 Min
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Pre-Hospital Alerts:
Door to First CT ≤ 30 Min
52% 55%
76%
53%50% 52%
65%76%
41%
63%
79% 77%
0%
20%
40%
60%
80%
100%
Sep'17
Oct Nov Dec Jan'18
Feb Mar Apr May Jun Jul Aug
PTOS & NPTOSAll Tr Activations
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Delay in Recognition/Decision:
Possible Barriers
■ Prehospital Identification
■ Triage
■ Full work up / imaging
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Delay in Recognition/ Decision: Opportunities
■ ATLS Guidelines
– Priority Imaging
– FAST
■ Educate providers
– Transport availability
■ Provide nursing education and autonomy
■ Rural Trauma Team Development Course (RTTDC)
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Our Solution: Expedited Criteria
■ Relationship with Level I/II
■ Transfer Center Process
■ Education
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Lack of Physical Transport :
Possible Barriers
■ Demographics
■ Inter-network vs Out of network
■ Inter-facility transport contracts
■ BLS/Volunteer squads
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Lack of Physical Transport: Opportunities
■ Strengthen & understand unique circumstances of each facility
■ Access to critical care transport
■ Identify any needs for ambulance agreements
■ Identify need for EMS education
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When Doesn’t This Work?!
■ Weather
■ Inability to obtain air transport
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Performance Improvement
■ Identify a leader
■ Invite your transfer facility to participate in one of your meetings
■ Provide prompt, detailed follow up
■ Transfer Center Recordings
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Transfers Out ≤ 3 Hrs
62%
38%
23%31%
56%
29%30% 33%
17%
42%
33%
58%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Sept'17
Oct Nov Dec Jan'18
Feb Mar Apr May Jun Jul Aug
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PTOS Transfer Times:
August
40%
100%
43%10%
14%10%14%
40% 29%
0%
20%
40%
60%
80%
100%
Non-Alerts Tr Alert (Highest) Tier II
August 2018 PTOS Transfers
≤ 3 Hrs 3-4 Hrs
4-5 Hrs > 5 Hrs
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What is the Message?
■ Education!
– Triage
– EMS
– Providers
– Nursing
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What we all would like to say…
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Performance Improvement
■ Identify a leader from these facilities
■ Invite your transfer facility to participate in one of your
meetings
■ Provide prompt, detailed follow up
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Transfers Out ≤ 3 Hrs
62%
38%
23%
31%
56%
29% 30%33%
17%
42%
33%
58%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Sept'17
Oct Nov Dec Jan'18
Feb Mar Apr May Jun Jul Aug
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PTOS Transfer Times:
August
40%
100%
43%10%
14%10%
14%
40% 29%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Non-Alerts Tr Alert (Highest) Tier II
August 2018 PTOS Transfers
≤ 3 Hrs 3-4 Hrs 4-5 Hrs > 5 Hrs
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Activation Transfers Out ≤ 3 Hrs:
Tr Alerts and Tier II
67% 69%
31%
22%
88%
36%
50%
82%
30%
57%
45%
71%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Sept'17
Oct Nov Dec Jan'18
Feb Mar Apr May Jun Jul Aug
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Door to CT ≤ 30 Minutes:
Trauma Alerts (Highest Level)
67%
45%
75%
56%50% 50%
60%
86%
33%
100%
64%
100%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Sep'17
Oct Nov Dec Jan'18
Feb Mar Apr May Jun Jul Aug
PTOS & NPTOS
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Door to CT Time:
Tier II Activations
24%
39%
62%
46%38%
34%40%
53%48%
51%59% 59%
80% 82%
96%
80% 78% 79%83% 81% 84% 86% 86% 86%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Sep'17
Oct Nov Dec Jan'18
Feb Mar Apr May Jun Jul Aug
PTOS & NPTOS
% Tier II ≤ 30 Min % Tier II ≤ 60 Min
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Pre-Hospital Alerts:
Door to First CT ≤ 30 Min
52%55%
76%
53%50% 52%
65%
76%
41%
63%
79% 77%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Sep'17
Oct Nov Dec Jan'18
Feb Mar Apr May Jun Jul Aug
PTOS & NPTOSAll Tr Activations