Use of a Mobile Remote Device to Optimize Pediatric Inter-facility Transportation: A Feasibility Study

Paediatric Specialized Inter-facility transport utilizes specialized teams usually made up of a respiratory therapist, paediatric critical care nurse, and paediatric intensivist as medical control. When a Nurse Practitioner or General Practitioner from a remote site has a paediatric acute care referral and wants to arrange transportation there is an initial call at which point there are two priorities: first is obtain a patient history and then provide advice to the remote caregiver to initiate specific therapies; second is to mobilize the specialized team to the patient. The period of time between giving initial advice while dispatching the team and the time when the team arrives, can often be a vulnerable period for the remote caregiver as well as the patient. The ability to directly visualize and assess the patient during this time, as well as assist the specialized team once they arrive may provide improvement in safety and care of the patient. It may also improve triaging and may make the stabilization and departure time more efficient.

Remote technology will be used for an initial patient assessment after being contacted by phone from the peripheral centre to transfer an acutely ill paediatric patient as assessed by the referral centre care provider. After assessment the patient will be triaged to either remain in the local community, transferred to a regional hospital that provides paediatric acute care (Prince Albert), or be transported to Royal University Hospital in Saskatoon for tertiary care. Data to be collected includes:

• Duration of time from the beginning of the initial phone call to the first therapeutic intervention
• Time to stabilization
• Time to decision for disposition
• The duration of contact with the health care provider and the patient
• Number of scheduled follow-up contacts for a specific patient within 24 hours
• Number of times the referring centre re-consults
• Of the patients who triaged to stay in the local community how many were transported to the tertiary care centre within 24hrs
• How many patients who arrived at the tertiary care centre were discharged within 24hrs
• How many patients on arrival were deemed to be unnecessary

The nurses and physicians who are communicating with the Intensivist about the case will complete a post-encounter survey to evaluate their experience.

Remote Technology Group Inclusion:

• Patients ≤ 17 years from peripheral centre (Pelican Narrows Clinic and Regina General Hospital).
• Acutely ill.
• Being considered for medical transport.

Control Group Inclusion:

• Patients ≤ 17 years from peripheral centre (Stony Rapids, Wollaston Lake and Sandy Bay).
• Chosen from a pre-existing Saskatchewan paediatric transport database.

Exclusion criteria

• Patients older than age 17.