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

CJEM ◽  
2020 ◽  
Vol 22 (S2) ◽  
pp. S30-S37
Author(s):  
Alanna Wong ◽  
Aidan McParland ◽  
Brodie Nolan
Keyword(s):  
Free Text ◽  
Transport Time ◽  
Trip Planning ◽  
Air Ambulance ◽  
Common Causes ◽  
Specialized Care ◽  
Total Transport ◽  
Medical Transport ◽  
Interfacility Transport ◽  
Manual Review

ABSTRACTObjectivesPopulation 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.MethodsCauses 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.ResultsOur 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).ConclusionsSome 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.

scholarly journals P141: Identifying causes of delay in interfacility transfer of patients by air ambulance

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S115
Author(s):  
A. Wong ◽  
A. McParland ◽  
B. Nolan
Keyword(s):  
Chart Review ◽  
Free Text ◽  
Transport Time ◽  
Trip Planning ◽  
Air Ambulance ◽  
Documentation Quality ◽  
Common Causes ◽  
Total Transport ◽  
Interfacility Transport ◽  
Manual Review

Introduction: Vast geography and low population density limit availability of specialized trauma and medical care in many areas of Ontario. As such, patients with severe illnesses often require a higher level of care than local facilities can provide and thus require an interfacility transfer to access tertiary or quaternary care. In Ontario, Ornge, a provincially run air ambulance, serves as the sole provider of air-based medical and critical care transport. Patient outcomes are impacted by the time to definitive care, yet little research about reasons for delay in interfacility transfer within Ontario has been conducted. This study aimed to identify causes of delay in interfacility transport by air ambulance in Ontario. Methods: Causes of delay were identified by manual chart review of electronic patient care records (ePCR). All emergent adult interfacility transfers for patients transported by Ornge between Jan. 1-Dec. 31, 2016 were eligible for inclusion. Patient records were flagged to be manually reviewed if they met one or more of the following criteria: 1) contained a standardized delay code; 2) the ePCR free text contained “delay”, “wait”, “duty-out”, or common misspellings therein; 3) were above the 75th percentile in total transport time; or 4) were above the 90th percentile in time to patient bedside, time spent at the sending hospital, or time to receiving facility. Each trip was categorized as having delays that fall into one or more of the following categories: time-to-sending delays, in-hospital delays, and time-to-receiving/handover delays. Results: Our search strategy identified 1,220 records for manual review and a total of 872 delays were identified. The most common delays cited included aircraft refuelling (234 delays); waiting for land EMS escort (144); and unstable patients requiring advanced care such as intubation, procedures, or transfusion (79). Other delays included handover or delays at the receiving facility (42); mechanical issues (36); dispatch-related issues (53); environmental hazards (43); staffing issues (47); and equipment problems (38). Conclusion: Some common causes of interfacility delay are potentially modifiable: better trip planning around refueling, and improved coordination with local EMS could impact many delayed interfacility trips in Ontario. Our analysis was limited by number and completeness of available records, and documentation quality. To better understand causes for delay, we would benefit from improved documentation and record availability.

Assessing the Difficulty and Time Cost of De-identification in Clinical Narratives

2006 ◽  
Vol 45 (03) ◽  
pp. 246-252 ◽  
Author(s):  
W. F. Phillips ◽  
S. Phansalkar ◽  
S. A. Sims ◽  
J. F. Hurdle ◽  
D. A. Dorr
Keyword(s):  
Regular Expression ◽  
Free Text ◽  
Time Cost ◽  
Clinical Notes ◽  
The Us ◽  
Important Challenge ◽  
Automated Technique ◽  
Manual Review ◽  
Simple Search ◽  
Selection Of

Summary Objective: To characterize the difficulty confronting investigators in removing protected health information (PHI) from cross-discipline, free-text clinical notes, an important challenge to clinical informatics research as recalibrated by the introduction of the US Health Insurance Portability and Accountability Act (HIPAA) and similar regulations. Methods: Randomized selection of clinical narratives from complete admissions written by diverse providers, reviewed using a two-tiered rater system and simple automated regular expression tools. For manual review, two independent reviewers used simple search and replace algorithms and visual scanning to find PHI as defined by HIPAA, followed by an independent second review to detect any missed PHI. Simple automated review was also performed for the “easy” PHI that are number- or date-based. Results: From 262 notes, 2074 PHI, or 7.9 ± 6.1 per note, were found. The average recall (or sensitivity) was 95.9% while precision was 99.6% for single reviewers. Agreement between individual reviewers was strong (ICC = 0.99), although some asymmetry in errors was seen between reviewers (p = 0.001). The automated technique had better recall (98.5%) but worse precision (88.4%) for its subset of identifiers. Manually de-identifying a note took 87.3 ± 61 seconds on average. Conclusions: Manual de-identification of free-text notes is tedious and time-consuming, but even simple PHI is difficult to automatically identify with the exactitude required under HIPAA.

Guidelines for Fixed Wing Air Ambulance Flights

1985 ◽  
Vol 1 (3) ◽  
pp. 294-297
Author(s):  
R.J. Fairhurst ◽  
Captain D. Antrobus
Keyword(s):  
International Travel ◽  
Insurance Companies ◽  
Air Ambulances ◽  
Air Ambulance ◽  
The Public ◽  
The United Kingdom ◽  
Legal Implications ◽  
Medical Transport ◽  
The Uk ◽  
Seriously Ill

The easy availability of small aircraft for charter, has been accompanied by increasing willingness on the part of insurance companies to pay the costs for the use of these air ambulances. Operators of aircraft in the United Kingdom and Europe were becoming increasingly worried about the moral, medical and legal implications of carrying seriously ill or injured passengers. In late 1980 the UK Air Taxi Operators Association (ATOA) began to formulate Guidelines for air ambulance operations, and in 1981 these were incorporated into the studies of the same subject by the International Business Aircraft Association (IBAA), Europe. This paper presents the Guidelines adopted by the ATOA and ratified by IBAA Europe. The Guidelines are designed not to hamper the development of aeormedical rescue, but to bring it within a proper medical aeronautical framework for the safety of the patients, and medical and aircraft crews.During the last 30 years development of the international travel market in Europe has resulted in many patients becoming ill or suffering injuries many miles from their own home. In the past these people would have remained in a local hospital and received treatment by the locally available facilities. There has been a revolution in the technology of medical transport, providing skills and equipment which allows the most seriously injured people to be transported over long distances. The public demand has pressed insurance companies to offer as part of travel packages the possiblity of medical repatriation. The number of new serious medical cases abroad reported to Europ Assistance in London, rose from 736 in 1978 to a projected 3,500 in 1983.

scholarly journals P043: Outcomes associated with prehospital refractory ventricular fibrillation

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S92
Author(s):  
M. Davis ◽  
A. Schappert ◽  
B. Chau ◽  
A. Leung ◽  
K. Van Aarsen
Keyword(s):  
Ventricular Fibrillation ◽  
Treatment Strategies ◽  
Spontaneous Circulation ◽  
Transport Time ◽  
Prehospital Treatment ◽  
Shockable Rhythm ◽  
History Of ◽  
Artery Disease ◽  
Hospital Cardiac Arrest ◽  
Manual Review

Introduction: When ventricular fibrillation (VF) cannot be terminated with conventional external defibrillation, it is classified as refractory VF (RVF). There is a paucity of information regarding prehospital or patient factors that may be associated with RVF. The objectives of this study were to determine factors that may be associated with RVF, the initial ED rhythm for patients with prehospital RVF, and the incidence of survival in patients who had RVF and were transported to hospital. Methods: Ambulance Call Records (ACRs) of patients with out of hospital cardiac arrest between Mar. 1 2012 and Apr. 1 2016 were reviewed. Cases of RVF (≥5 consecutive shocks delivered) were determined by manual review of the ACR. ED and hospital records were analyzed to determine outcomes of patients who were in RVF and transported to hospital. Descriptive statistics were calculated and all variables were tested for an association with initial ED rhythm, survival to admission, and survival to discharge. Results: Eighty-five cases of RVF were identified. A history of coronary artery disease (47.10%) and hypertension (50.60%) were the most common comorbidities in patients transported to the ED with RVF. Upon arrival to the ED, 24 (28.2%) remained in RVF, 38 (44.7%) had a non-shockable rhythm, and 23 (27.1%) had return of spontaneous circulation. Thirty-four (40%) survived to admission, while only 18 (21.2%) survived to discharge. Pre-existing comorbidities, time to first shock, time on scene, and transport time were not statistically associated with initial ED rhythm, survival to admission or discharge. Patient age was statistically associated with improved rhythm on ED arrival (p=0.013) and survival to discharge (58.24 yrs vs 67.40 yrs, Δ9.17, 95% CI 1.82 to 16.52, p=0.015). Conclusion: The majority of patients with prehospital RVF have a rhythm deterioration by the time care is transferred to the ED. Of these patients with a rhythm deterioration, few survive to hospital discharge. Younger patients are more likely to remain in RVF and survive to discharge. Further research is required to determine prehospital treatment strategies for RVF, as well as patient populations that may benefit from those treatments.

Utilization of Warning Lights and Siren Based on Hospital Time-Critical Interventions

2010 ◽  
Vol 25 (4) ◽  
pp. 335-339 ◽  
Author(s):  
Andreia Marques-Baptista ◽  
Pamela Ohman-Strickland ◽  
Kimberly T. Baldino ◽  
Michael Prasto ◽  
Mark A. Merlin
Keyword(s):  
Life Support ◽  
Advanced Life Support ◽  
Time Of Day ◽  
Average Difference ◽  
Transport Time ◽  
Day Of The Week ◽  
Medical Transport ◽  
Critical Patients ◽  
Time Critical ◽  
Warning Lights

AbstractObjective:The objective of this study was to evaluate the time saved by usage of lights and siren (L&S) during emergency medical transport and measure the total number of time-critical hospital interventions gained by this time difference.Methods:A retrospective study was performed of all advanced life support (ALS) transports using lights and siren to this university emergency department during a three-week period. Consecutive times were measured for 112 transports and compared with measured transport times for a personal vehicle traveling the same day of the week and time of day without lights and siren. The time-critical hospital interventions are defined as procedures or treatments that could not be performed in the prehospital setting requiring a physician. The project assessed whether the patients received the hospital interventions within the average time saved using lights and siren transport.Results:The average difference in time with versus without L&S was -2.62 minutes (95% CI: -2.60− -2.63, paired t-test p <0.0001). The average transport time with L&S was 14.5 ±7.9 minutes (min) (1 standard deviation/minute (min), range = 1–36 min.). The average transport time without L&S was 17.1 ±8.3 min (range = 1−40 min). Of the 112 charts evaluated, five patients (4.5%) received time-critical hospital interventions. No patients received time-critical interventions within the time saved by utilizing lights and siren. Longer distances did not result in time saved with lights and siren.Conclusions:Limiting lights and siren use to the patients requiring hospital interventions will decrease the risks of injury and death, while adding the benefit of time saved in these critical patients.

scholarly journals Geointelligence against Illegal Deforestation and Timber Laundering in the Brazilian Amazon

2020 ◽  
Vol 9 (6) ◽  
pp. 398 ◽  
Author(s):  
Franco Perazzoni ◽  
Paula Bacelar-Nicolau ◽  
Marco Painho
Keyword(s):  
Evaluation Criteria ◽  
Brazilian Amazon ◽  
Benford’S Law ◽  
Transport Time ◽  
Clear Cutting ◽  
Forest Inventories ◽  
Brazilian Legislation ◽  
Benford's Law ◽  
Total Transport ◽  
Impossible Task

Due to the characteristics of the Southern Amazonas Mesoregion (Mesorregião Sul do Amazonas, MSA), conducting on-site surveys in all licensed forestry areas (Plano de Manejo Florestal, PMFS) is an impossible task. Therefore, the present investigation aimed to: (i) analyze the use of geointelligence (GEOINT) techniques to support the evaluation of PMFS; and (ii) verify if the PMFS located in the MSA are being executed in accordance with Brazilian legislation. A set of twenty-two evaluation criteria were established. These were initially applied to a “standard” PMFS and subsequently replicated to a larger area of 83 PMFS, located in the MSA. GEOINT allowed for a better understanding of each PMFS, identifying illegal forestry activities and evidence of timber laundering. Among these results, we highlight the following evidences: (i) inconsistencies related to total transport time and prices declared to the authorities (70% of PMFS); (ii) volumetric information incompatible with official forest inventories and/or not conforming with Benford’s law (54% of PMFS); (iii) signs of exploitation outside the authorized polygon limits (51% of PMFS) and signs of clear-cutting (43% of PMFS); (iv) no signs of infrastructure compatible with licensed forestry (24% of PMFS); and (v) signs of exploitation prior to the licensing (19% of PMFS) and after the expiration of licensing (5%).

scholarly journals Clinical Research of Mortality in Emergency Air Medical Transport

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Wan-Lin Chen ◽  
Hon-Ping Ma ◽  
Chih-Hsiung Wu ◽  
Hung-Yi Chiou ◽  
Yun Yen ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Physician Density ◽  
Main Island ◽  
National Health Care ◽  
The Past ◽  
Medical Transport ◽  
Remote Islands ◽  
Increasing Demand ◽  
Interfacility Transport ◽  
Overall Mortality

Introduction.EAMT in Taiwan has experienced increasing demand in the past few years. The objective is to analyze the trend of EAMT in the past six years and mortality rate within three days of patients undergoing interfacility transport in Taiwan.Material and Method.We conducted a retrospective review of patients who were airlifted from remote islands to main island between 2006 and 2011. Main outcome measures are EAMT number (EAMT-N), EAMT per thousand population (EAMT frequency, EAMT-F), number of mortality (Mor-N), and mortality rate within three days after EAMT (Mor-R).Results and Discussion.Overall mortality rate is 7.54% in 1684 airlifted patients. Acute myocardial infarction (AMI, 26.3%) and traumatic brain injury (TBI, 25.8%) comprise the majority in diagnosis (52.1%). However, Mor-Rin these two categories is significantly low in AMI (3.5%) and TBI (5.1%).Conclusion.The present study demonstrates that physician density is not related to EAMT-Nbut to physician number. As general population ages (10%), the average age of patient who underwent EAMT doubled (21%). This study also leaves room for discussion regarding futile medical care. The results can be used as a reference for increasing utilization of EAMT in current National Health Care Scheme.

Abstract 2319: Improving Inter-facility Transfer Times for Acute Ischemic Stroke Patients: The Stroke Rescue Program

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Jeffrey M Katz ◽  
Richard Libman ◽  
Paul M Power ◽  
Adelyn Tsu ◽  
Nimmy Thomas ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Health System ◽  
Acute Ischemic Stroke ◽  
Treatment Guidelines ◽  
Phone Call ◽  
Network Efficiency ◽  
Transport Time ◽  
Total Transport ◽  
Comprehensive Stroke Center ◽  
Rapid Transfer

Background and Purpose: The inter-facility transfer of acute ischemic stroke (AIS) patients to a comprehensive stroke center (CSC) must be rapid. Transfer delays increase the likelihood of exclusion from endovascular stroke therapy and therefore are an obstacle to time sensitive stroke treatments. Reducing transport times and improving transfer efficiency is integral to the success of a comprehensive stroke network. Methods: The Stroke Rescue Program was created within a large metropolitan health system to facilitate the rapid transfer of AIS patients from regional (both health system (n=8) and non-system (n=4)) primary stroke centers (PSC) to the network's CSC. Program interventions included creation of a transfer center and stroke rescue hotline with a new priority dispatching protocol; standing order medical treatment guidelines with paramedic, referring physician and staff education; and the development of transport time elements and targets. Selected time elements included Transport 1 (Tr-1, initial phone call to EMS arrival at PSC), ED Time (PSC arrival to PSC departure), and Transport 2 (Tr-2, PSC departure to CSC arrival). Total transport time target was set at <60 min and to achieve this we aimed at decreasing ED Time. Results: Between January 1, 2010 and June 30, 2011, 128 patients underwent Stroke Rescue. The median PSC to CSC distance was 14.4 miles (range 3.0 to 32.1 miles). Ischemic stroke was confirmed in 116 (91%) patients and 65 (51%) patients were “drip and ship” transports (intravenous tPA infusion during Tr-2). Overall, median total transport time was 48 min (ED Time 18 min). Comparing first quarter 2010 (baseline quarter, n=21) to second quarter 2011 (most recent quarter, n=31), the percent transported within 60 min increased from 57% to 81%. Statistically significant improvement was seen for both median ED Time (23 min versus 14 min; U = 171, p <.01, r = .40) and median total transport time (56 min versus 44 min; U = 199, p <.05, r = .33). Conclusion: Process organization with inter-facility stroke transfer protocols that minimize the time paramedics spend in a PSC emergency department can significantly reduce transport duration making transfer for time limited stroke therapies practical. Further study is needed to determine whether improved stroke network efficiency translates into better clinical outcomes, but the concept of “time is brain” supports this approach.

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