8 What’s Taking So Long: A Retrospective Review of Factors Influencing Bedside Time in Interfacility Transfer

Abstract

The focus on reducing door-in door-out times has created substantial scrutiny on the time emergency medical services (EMS) crews spend preparing patients for interfacility transport, referred hereafter as the “bedside time.” Several limited process improvement studies have shown that disease-state-specific interventions can reduce bedside time. Clinical complexity in the EMS transport environment are the clinical elements that need to be considered in managing the transport. Equipment and hemodynamic stability are the two major clinical considerations. The goal of this study was to determine the extent to which clinical complexity is associated with bedside time. A dataset including clinical and operational data for two years (2018 and 2019) of inter-facility transfers was downloaded from the electronic patient care record system (HealthEMS, Stryker). This dataset included all inter-facility transfers at the Advanced Life Support (ALS) level or higher. Clinical complexity was measured using variables, including initial vital signs and the use of special equipment such as a ventilator, BiPap, intra-aortic balloon pump, and the number of infusion pumps. The number of crew on the transport assignment was captured as occassionally there are transports with an additional paramedic. Transports identified as a rescue for stroke, STEMI, cardiothoracic, or trauma were identified. A multivariable linear regression model was performed to identify factors related to clinical complexity associated with beside time (minutes). Data from 1, 196 patient encounters were analyzed. Ventilator use (β=16.39), non-invasive ventilation (β=7.19), balloon pump (β=14.38), initial heart rate (β=0.06 for each unit increase in heart rate), were independently associated with increased bedside time. Rescue/STEMI coding (β=-19.38) was independently associated with decreased beside time. Bedside time is a predictable function of clinical complexity of the patient being transported. Efforts to minimize bedside time should focus on reducing interventions that are not necessary for transport or reducing the task time for the individual components involved in transport. Further research is needed to assess the types interventions that can safely expedite bedside time.