The New Jersey EMSC Program, in partnership with the Burlington County College, is conducting “Emergency Department Evaluations through Simulation” at New Jersey hospitals. The goal of the simulation project is to evaluate and improve pediatric readiness and responsiveness. The evaluation includes observation of treatment(s) provided by staff as well as transfer processes that would be followed for pediatric patients when appropriate resources are unavailable.
The use of clinical scenarios and simulation mannequins allows the EMSC Advisory Board members, Burlington County College faculty, and state EMSC staff opportunities to:
- observe policies and procedures essential to care of the pediatric patient;
- identify quality improvement opportunities;
- ensure pediatric equipment availability;
- identify potential staff training needs; and
- evaluate pediatric EMS registry documentation processes.
Positive outcomes that have already resulted from the simulation project include:
- The development of an evaluation tool that accurately assesses current transfer processes and treatments while facilitating improvement conversations with staff.
- The participation of staff in identifying potential gaps in the emergent transfer of patients.
- The opportunity for evaluators and EMSC leadership to work with staff on strategies to improve the quality of care rendered during transfer.
In March 1999, the Vermont State Hospital Association created the state’s master interfacility patient transfer agreement and guidelines to be followed by all Vermont hospitals. At that time, each of these facilities agreed to (1) accept transferred patients from one another, and (2) utilize the guidelines outlined in the master document. Indicating their support and commitment to the process, all 17 hospital administrators signed the document.
When the federal EMSC program announced the creation of EMSC performance measures, the Vermont EMSC program and EMS director investigated state processes to assure timely and safe interfacility patient transfers. The following information was gleaned from the investigation:
- The master agreement and guidelines had not been updated since development.
- Signatories were not necessarily still with the hospitals.
- The master agreement and guidelines did not specifically identify pediatric patients.
- Though hospitals leaders were not always aware that the master agreement and guidelines existed, they agreed that the standard procedures as outlined in that document should be kept, utilized, and updated.
Developing a collaborative partnership with the Hospital Preparedness Program (HPP) administered through the U.S. Department of Health and Human Services proved to be a critical step in updating the master document with the integration of pediatric concerns. The state’s health department had previously identified transfers to be of vital importance during mass casualty incidents and pandemic flu outbreaks. Other partners in championing updates to the master agreement and guidelines included Vermont’s Office of Rural Health and the Vermont Hospital Association.
In 2006, Washington EMSC conducted a survey to determine the number of hospitals with pediatric interfacility transfer agreements and guidelines. Survey results indicated a need to develop comprehensive state-wide guidelines. Draft pediatric interfacility guidelines were then developed by the EMSC manager with guidance and feedback from the EMSC Advisory Committee, the State Trauma Nurse Coordinators, and the EMSC National Resource Center.
As the guidelines were developed, each draft was distributed to various groups for review, and finally presented to the state’s EMSC Advisory Council for approval. To assure clear understanding among all groups involved, the EMSC program manager participated in numerous statewide meetings to explain the need for the guidelines. The proposed document was introduced as a template that individual hospitals could adapt to accommodate specific situations and facilities in the development of their own pediatric transfer guidelines.
For more information about these process, see Best Practices: A Guide for State Partnership Grantees on the Implementation of EMSC Performance Measures. (June 2006)