The Online Newsletter for Children's Nurses
e-Edition, Issue 5
Critical Care Transport Excellence
Jennifer Reyes, BSN, RN-NIC
Manager, Transport Department
Children's Hospital Central California has become one of the largest children's hospitals in the nation today. Currently, the Critical Care Transport Team consists of Intensive Care Unit (ICU) Registered Nurses and 11 Intensive Care Unit Respiratory Therapists, who annually transport over 1,500 critically ill and injured neonates and children. In 2009, this dedicated team completed 1,019 neonatal transports and 583 pediatric transports. This dedicated specialty team travels by ambulance, helicopter and plane to cover a 45,000 square-mile referral area that stretches from Stockton to Bakersfield and from the Sierras to the Pacific Ocean.
The transport team utilizes a nurse-led model, when other similar teams include a resident or nurse practitioner. Each team member has specialized training and possesses extended practice certifications in their area of specialty. They routinely serve as resources to newer staff, are utilized in leadership roles in the ICUs, and provide guidance and education to the staff at referring facilities. Many of these team members have been transporting together for years, even decades, resulting in teamwork that is completely second nature. They have an immense trust in one another which creates an atmosphere of collaboration, to the point that they can walk into an unfamiliar crisis situation and within minutes prioritize, process, and begin treating their patient, putting that child on the road to recovery from their very first touch. Their expertise comes from years of clinical practice and dedication to the field of pediatric and neonatal transport medicine.Together, the nurse team has 112 and the respiratory team has 141 combined years of transport experience.
During this past year, the Critical Care Transport Team has used their expertise and a driving initiative to work on a number of projects to enhance patient safety. In order to better secure the multitude of medications required for an intensive care transport, members of the team collaborated with the Pharmacy Department. They were challenged with developing a system for improving the security of emergency medications during transport. Ultimately, the group constructed a process that not only enhanced patient safety, ensuring that every medication bag was secured by a Pharmacist, but also minimized additional workload on Pharmacy staff by having the transport nurses continue their process of restocking and charging for medications given on transport. The team was also able to minimize the cost of the process change by utilizing already existing storage cabinets to secure and store transport medication bags and stock.
The team has also taken a great deal of initiative in collecting neonatal transport data, which is then submitted to California Perinatal Quality Care Collaborative (CPQCC) in partnership with California Perinatal Transport System (CPeTS). Performing over 900 qualifying emergent neonatal transports each year, Children's team is a leader in neonatal transport. When CPQCC partnered with CPeTS and began mandating the reporting of neonatal transport data in January 2007, the team examined how the data would be collected, documented and reported. After learning about the process from CPQCC and auditing a few past submissions, the team decided that they were the best group to sort through the records to make sure the data was as accurate as possible. Transport leadership began introducing the data forms and collection process in meetings with referring facilities. They worked with Communications and Marketing to make the data forms available via the Hospital's website for easy access. Additionally, transport team members were trained on gathering the data and then provided outreach education to referring staff during transports. A small contingency of the team was then trained on submitting data to the CPQCC database. Today we enjoy the opportunities for quality assurance and improvement that participation in this project provides.
Through the data reports provided by CPQCC, the transport team has been able to compare themselves to the entire CPQCC network of teams, as well as regional Neonatal Intensive Care Unit (NICU) transport teams. Not only does Children's Hospital have a transport team that possesses expertise in the field of transporting infants and children, there is also data to support that they transport quickly and that their patients do very well. Highlights include:
- Children's Hospital Transport Teams depart for the referring facility in an average of 52 minutes, while other regional teams depart in an average of 74 minutes.
- From the time the patient is referred to Children's to the time the transport team arrives at the patient's bedside is only an average of 1 hour 38 minutes, as compared to 2 hours and 39 minutes for other regional teams. Although the team is covering a 45,000 square-mile referral region, they are able to get to their patient faster than other teams. This transport team is not only quick, but the ICU care they provide is just what their patients need.
- According to CPQCC data, 88.9 percent of infants transported by Children’s Hospital Transport Team have a modified TRIPS score of 30 or less, equating to a less than 4 percent probability of mortality within seven days of NICU admission. This is in comparison to other CCS regional NICUs, where 86.9 percent of transported patients have a less than 4 percent probability of mortality within seven days of NICU admission.&.
While this team is already a leader in this subspecialty field, they continue to strive for excellence, knowing there is always room for improvement when impacting thousands of children's lives. This is an amazing nurse team providing incredible care!
In This Issue
Nursing Rights and Responsibilities
Nurse of the Year 2010
PICU Beacon Award
Critical Care Transport Excellence
A Culture of Inquiry
Nursing Governance Outcomes
Parents As Partners In Care
Contributions to Practice
Contributions to New Knowledge - Nursing Research
Leadership In Professional Nursing Organizations