Quicker team launch times for urgent priority neonatal retrievals: A Quality Improvement Initiative study

TL;DR

This study shows how a neonatal transport service improved its response times for urgent infant transfers using quality improvement methods.

Contribution

A novel application of quality improvement cycles to significantly reduce critical time metrics in neonatal emergency transport.

Findings

Launch times for urgent neonatal retrievals decreased from 35.5 to 17.0 minutes after implementing quality improvement measures.

First look time improved from 85.0 to 52.5 minutes, showing faster response to urgent transport decisions.

Total retrieval time was reduced from 243.5 to 182.0 minutes, though this change was not statistically significant.

Abstract

Neonatal retrieval networks have adopted time-centric quality metrics as Key Performance Indicators (KPI) for setting and comparing benchmarking standards. Quicker launch time (departure from base), an essential KPI, enables neonatal retrieval teams to rapidly provide higher-level care to sick infants. The Newborn Emergency Transport Services of Western Australia (NETS WA) facilitates neonatal transfers across largest global retrieval area necessitating quicker team launch times for urgent retrievals. NETS WA conducted a quality improvement (QI) study to quicken team launch times for urgent retrievals.

The smart aim was to quicken NETS WA team launch times on urgent retrievals to comply with the recent Australian New Zealand Neonatal Retrieval Network 2022 benchmark ( < 15 min). Secondary aims included impact of quicker launch times on “first look time” (time from decision to retrieve to presence at bed side) and “total retrieval time” (total time taken from the decision to transport until the handover of the patient at the receiving hospital).

This study was completed over two years in NETS WA. Urgent priority retrievals are 10–15% of total transfers (120–180/year).

Plan-Do-Study-Action (PDSA) cycles: 1. Immediate access to transport cots 2. Additional personnel 3. Pre-defined priority matrix 4. Direct communication strategies. Launch time, first look time and total retrieval time were gathered from an electronic retrieval database (REDCap). Data collection were done at baseline (January–May 2022), during PDSA cycles (June 2022–April 2023) and after last PDSA cycle (May–December 2023).

Times are expressed as median (interquartile range IQR) in minutes. Comparisons were made for all transports and for road and air transports separately. Launch times decreased from 35.5 (21.5–90.0) at baseline to 17.0 (11.0–37.0) minutes (p 0.0006) after the last PDSA cycle for all urgent priority retrievals. Launch times for road only decreased to 15.0 (10.0–20.0) minutes (p 0.009). First look time decreased from 85.0 (54.8–269.3) to 52.5 (30.5–152.3) minutes (p 0.008). Total retrieval time changed from 243.5 (135.8–395.3) to 182.0 (117.0–390.0) minutes (p 0.33).

Well-designed QI measures enabled NETS WA teams to quicken essential time-centric quality metrics for urgent priority neonatal retrievals.

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