Reduction in retrieval mobilisation time over a 5-year period (South Thames Retrieval Service)

Abstract

Introduction The South Thames Retrieval Service (STRS) is a specialised paediatric intensive care retrieval service, integrated into the Evelina Children's Hospital, the lead centre in the South Thames Region, London. Over the last 5 years a number of initiatives have been adopted to reduce mobilisation times (the time from retrieval acceptance and activation to departure from the lead centre) and improve service delivery to surrounding district general hospitals (DGHs). The aim of this study was to evaluate whether these initiatives led to a reduction in mobilisation time between January 2002 and December 2006. Methods The STRS covers 24 DGHs within an 80 mile range serving a population of 1.6 million children in the South Thames region of Greater London. All calls to the service were logged on a detailed database. Retrieval requests for potential PICU patients were triaged and coordinated via a retrieval-specific telephone line. Once accepted, the onsite retrieval team was mobilised and dispatched via a dedicated ambulance to the DGH. Mobilisation includes assimilating and checking pre-packed equipment bags (ventilators, drugs, intubation kit, monitors, and so on) and organising a team of at least one retrieval nurse, doctor and ambulance driver. Details of each retrieval request to the STRS, including the time of the call, were captured on a database containing the patient demographic and clinical details. The interval between accepting the patient for retrieval and team departure from the unit was termed the 'mobilisation time' (minutes). Data were analysed over two time periods, before (n = 976 retrievals) and after 2004 (n = 1,785), coincident with a dedicated ambulance and driver on site. Nonparametric tests were used for continuous data (Kruskall–Wallis test or Mann–Whitney test) and the chi-squared test for categorical 2 × 2 comparisons. Results A total of 2,761 retrievals (median age 12 months, 78% ventilated) were performed and included for analysis during the study period, 33 were excluded (missing mobilisation times (n = 30) or elective transfers (n = 3). Figure 1 shows the process introduced to improve mobilisation times with a dedicated onsite ambulance service in 2004. There was a significant reduction in mobilisation time from 2002 to 2006 from 55 minutes (IQR 35–80) to 30 minutes (IQR 25–50), P < 0.0001 (Kruskall–Wallis) (Figure 2). When comparing pre-2004 and post-2004 time periods, the median mobilisation time was significantly lower after 2004 with a fall from 45 minutes (IQR 30–70) to 35 minutes (IQR 27–55). There was also a significant increase in the incidence of sub-30-minute mobilisation times, which almost doubled after 2004 with the availability of an onsite dedicated ambulance service (14.3% to 25.9%, P < 0.0001). Figure 1 Processes introduced to improve mobilisation times. Figure 2 Median retrieval mobilisation times. Conclusion There has been a significant decrease in the mobilisation time of the STRS over the last 5 years. Although the presence of an onsite ambulance service in 2004 had a significant impact on reducing retrieval mobilisation times, a number of other factors and initiatives contributed to steadily reducing mobilisation times over the study period.