Organization and Mission

Children’s Hospital Medical Center of Akron (CHMCA) is a 253-bed freestanding pediatric facility. The hospital includes a level 3 neonatal intensive care units (NICU) and a level 2 trauma center. CHMCA also operates a burn unit that accepts all patients of all ages.

Akron’s Children’s Transport (ACT) operates three ground ambulances and works with other services that provide rotor-wing and fixed-wing air ambulances. ACT generally covers 22 counties in northeast Ohio, but will transport children by fixed-wing aircraft back to CHMCA from anywhere in the continental United States. The ambulances are staffed with a nurse, paramedic and respiratory therapist. ACT provides only interfacility transfer services.

More information is available at www.akronchildrens.org.

Systems Integration
In 2001, CHMCA implemented a centralized communications center to improve communications between referring physicians and CHMCA. CHMCA’s performance improvement process identified that the prior system was ineffective and inefficient. Callers were getting lost in the system. Referring physicians who called in with a patient to be transferred were being left on hold for lengthy periods of time.

Under the current system, all transport and EMS calls come in to the communication center. When interfacility transfer is required, the referring physician, transport nurse, and physician providing medical direction at CHMCA confer about the patient. They discuss criticality, patient needs, and appropriate mode of transportation. Once the call is accepted, CHMCA handles all the coordination, even if the patient is not being transported to CHMCA.

Implementation Strategy
Once the performance improvement process had identified the need for a better approach, a transport steering committee consisting of management, the medical director for transportation, the vice president of nursing, and representatives from pediatrics, NICU, trauma, respiratory therapy, and pharmacy met monthly. The creation of the communications center was the result of the committee’s work.

Because CHMCA was working on what was perceived to be a problem and because all the relevant stakeholders participated in developing the solution, the committee approach was successful in garnering internal support that has made the communications effective.

Implementing the communications center required building and equipping a dedicated facility. In addition to the hardware requirements, CHMCA had to update its clinical and operational databases in order for the system to work effectively. As a result, CHMCA is able to analyze 22 aspects of every transport: for example, origin, diagnosis, call volumes, frequency and distribution of calls, staff deployment, and a range of clinical and treatment variables.

Evaluation and Results
The communications center has been effective in decreasing response time from 15 minutes down to 10 minutes. In addition, because the whole team has the information necessary for that transport, it can set up necessary care faster. With the implementation of the communications center, the whole process is more efficient, particularly as it affects the referring physician. In the current system, a support staff member can place the initial call. When the team is assembled, the referring physician can join the call, maximizing the time the physician can spend with the patient.

CHMCA regularly surveys the referring physicians and has received very positive feedback. Also, referring physicians receive a letter describing where and to what service the patient was admitted. As a result the volume of transports has increased from 900 in 1999 to 1,468 in 2004. Referring physicians report satisfaction with their increased role in patient triage.

Education and Replication
One of the positive side effects of the improved working relationship has been requests by referring hospitals for CHMCA to send a team to do outreach at their facilities. The team addresses the capabilities of CHMCA and ACT. By going to the outlying facilities, the outreach team can work with the particular circumstances of the referring facility to enhance communication, preparation for transport, and follow-up.