Minor Changes—Monumental Impact: Utilizing Direct Care Staff to Improve Critical Care Transport Services

Purpose:
In trauma or illness, access to specialized critical care services can mean the difference between life or death. To better serve patients and improve outcomes, a Critical Care Transport Team (CCTT) evaluated the effectiveness and efficiency of staff scheduling processes to reduce missed transports.

Significance:
The CCTT Operations Committee (OC) evaluated the CCTT's staffing and scheduling plan efficiency and effectiveness in relation to transport activity, focusing on missed transports. Trends were identified that supported evaluating current CCTT scheduling to meet the current transport request demands.

Strategy and Implementation:
The CCTT's daily staffing plan provided the following coverage: 0700-1930: 2 Teams 1000-2230: 1 Team 1700-0530: 1 Team 1900-0730: 2 Teams The OC utilized data such as total missed transports, missed/delayed transports due to team availability, transport request time of day, frequency of open shifts, and transport activity between campuses to evaluate scheduling practices and their impact on operations, safety, and costs. CCTT staff also completed a survey assessing various topics such as work environment, communication and clinical outcomes. This information supported replacing the 1700 shift, which was viewed as undesirable and difficult to staff, with a 1500 shift. Data also revealed that the transport request volumes increased nominally between 1200 and 0230. The 1500 shift provides more appropriate coverage for this surge. The new staffing model would also allow the 24-hr shift CCTTs adequate time to sleep in the early morning hours when fewer transport requests come in.

Evaluation:
In the first year, the number of missed transports due to availability decreased by 36.6% during the hours of the new 1500 shift. When comparing data from 11/08-02/09 and 11/10-02/11, the busiest transport months, the percent of missed transports of total requests decreased from 8.6% to only 4.5%.

Implications for Practice:
These improvements can be directly attributed to the OC's recommendations. By engaging direct care staff in evaluating the effectiveness and efficiency of staffing, the CCTT has been able to enhance the services provided for pediatric patients and families needing critical care transport services.