(5) Use of Secure Texting to Improve Inter-facility Critical Care Transport Time

Mary Asal; Jonathan Berkowitz

doi:10.1542/peds.142.1_MeetingAbstract.15

Texting could become a key component in improving outcomes for critical care patients. Using text messaging within the field of healthcare has been highly debated; however, due to its established place in modern communication culture, the eventual use of texting is inevitable. Initial research regarding the use of electronic communication for outpatient health improvement has begun to surface, but there is a paucity of literature regarding the use of texting within inpatient and emergency healthcare systems as a means of quality and outcome improvement. In critical care transport, improvement of the 90th percentile for response time is a quality metric standard persistently addressed through analysis of potential system modifications. By decreasing time to appropriate care, overall morbidity and mortality can also be decreased. One limiting factor in patient transport with potential for improvement is time to dispatch of receiving team. Dispatch time is generally dependent on physician acceptance of patients after request is relayed from a requesting facility through a transfer center, even though clinical staff often know whether or not the patient will be transported. This study aims to show that implementation of secure texting between transfer centers and Critical Care Transport Teams can significantly reduce the time to dispatch, in turn decreasing overall transport time between facilities and improving patient outcomes. A HIPAA-compliant, secure texting system (TigerText) was implemented between the regional transfer center and Westchester Medical Center’s (WMC) Critical Care Transport (STAT) Team. Upon receipt of a patient transfer request, the transfer center simultaneously messaged information to the STAT team and called the potentially accepting facility. STAT team self-dispatch was instated upon receipt of transfer center data, as decided through use of an algorithm, which considered vehicles available, diagnosis as provided by the sending physician, age of patient, and requesting facility distance. This allowed for transport dispatch prior to official facility acceptance, which can be delayed due to the accepting physician’s unavailability for immediate request and report. Transport data over five years was compiled and analyzed to determine average transport times from healthcare facilities to WMC Pediatric ED or PICU. Seventeen Facilities with at least 35 transports and at least 10% of transports after implementation of the TigerText system were considered in analysis. Average transport times prior to and after implementation of TigerText system were compared with improvement seen in 15 of 17 facilities after implementation. Average time saved from any facility was 15.28 minutes (Range 1.4-34.26), with 60% of hospitals improving by at least 12 minutes. This study indicates potential for significant improvement of transportation efficiency—and therefore patient outcomes—as a direct result of secure texting between transfer centers and STAT teams alongside self-dispatch algorithms.