Impact of Prepatching on Paramedic In-Hospital Times for Emergent Interfacility Transfers

Abstract

Background: The care required for patients at times necessitates they be transferred to another hospital capable of providing specialized care, a process known as an interfacility transfer. Delays to appropriate care for critically ill patients are associated with increased morbidity and mortality. Improving efficiencies in interfacility transport process can thus expedite the time to critical treatment. Traditionally paramedics would patch to a transport medicine physician (TMP) after initial patient contact to discuss the case and expected management during transport. The concept of prepatch shifts this discussion between the TMP and paramedics prior to initial patient contact. The objective of this study was to assess if prepatching with paramedics prior to arrival at the patient reduced the in-hospital time for emergent interfacility transfers transported by a provincial critical care transport organization. Methods: This was a retrospective cohort study of all emergent, adult interfacility transports for patients transported by a provincial critical care transport organization in Ontario, Canada from January 2016 to December 2019. Quantile regression was used to evaluate the impact of prepatching as well as patient and paramedic characteristics on paramedic in-hospital time. Results: A total of 10,088 patients were included in the study, with 3,606 patients having a prepatch conducted and 6,482 without. Ventilated patients and vasopressor use were associated with higher prepatch rates; with the use of prepatch in these patients increasing over subsequent years of the study. Additionally, patients requiring higher levels of care, including being mechanically ventilated or dependent on vasopressors, were associated with longer in-hospital times. Prepatching reduced in-hospital time by 4 minutes at the 90th quantile across all patients. Conclusion: Prepatching reduced paramedic in-hospital time for emergent interfacility transports. Although the clinical impact of this reduction in time is uncertain, prepatching may serve in facilitating shared mental modeling between paramedics and TMPs which may be beneficial to patient safety and team performance.