Background: In August 2020, the New York-Presbyterian Weill Cornell NICU relocated to a new maternity and neonatal hospital facility. In preparation for this, a multidisciplinary team developed a transfer tool to facilitate patient movement. Objective transport assessment tools have been used to predict patient stability in adults and guide medical decision making prior to interfacility transport. This data has been extrapolated to the pediatric population, and checklists have been designed in an effort to reduce the risks associated with transport. The key elements of the safe transport of patients includes pre-transfer stabilization and preparation, appropriate personnel and equipment required during the transport, and patient handover.
Objective: To pilot an interfacility transport tool and to report an experience with the large-scale relocation of hospitalized critically ill newborns.
Methods: A quality improvement initiative was started to create a transport checklist for the interfacility transport of neonates. Plan: A need for standardized planning and handoff during patient transports. A multidisciplinary team developed a transport tool consisting of a pre-transport checklist and handoff. The pre-transport checklist includes five sections to be completed at different intervals prior to patient transport, and the handoff tool includes patient-specific clinical information (Figure 1) Do: The transport tool was piloted during the interfacility transport of a Level IV NICU to a new location. Study: Transport tools were reviewed for completion and a survey using a 5 point Likert scale (1=strongly disagree, 5=strongly agree) regarding the ease of use and impact on transport planning was distributed to neonatal nurses (Figure 2).
Results: 32 patients were transported over an eight hour period. Patient characteristics are listed in Table 1. Transport tools were reviewed for 31/32 patients. Completion of the pre-transport checklist boxes was as follows: Box A 28/31 (90%) Box B 28/31 (90%) Box C 18/31 (58%) Box D 11/31 (35%) Box E 15/31 (48%). Respiratory settings, continuous intravenous infusions, feeding status, code status, and isolation precautions were completed on the handoff tool for > 95% of patients. Results from the nursing survey are pending.
Conclusion: While this transport tool was designed for an interfacility relocation, the tool provides a standard checklist and handoff instrument to reduce variability in transport planning, and may be adapted for interfacility transports. The transport checklist was more likely to be used the day prior to transport than the day of transport. Overall, the handoff tool was more likely to be completed than the pre-transport checklist. Feedback from the nursing survey will help to revise the pre-transport checklist to better match the current workflow surrounding transports.
