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Original Research

High Acuity Rural Transport: Findings from a Qualitative Investigation

AUTHORS

name here
Jude Kornelsen1
Associate Professor, Associate Professor *

Brent Hobbs2 RN, BSN, CNCC(c), Network Director

Holly Buhler3 MMedSc, MGIS(c), Research Analyst

Rebecca Kaus4 B.A, CAPM, MBA, Project Lead and Business Analyst

Kari Grant5 CCHRA(c), Medical Affairs and Clinical Network Analyst

Scott Lamont6 BSN, RN, CCRN, CFRN, Patient Care Coordinator, Kooteney Boundary HART

Stefan Grzybowski7 MD, Medical Doctor

AFFILIATIONS

1, 7 3rd Floor David Strangway Building, 5950 University Blvd. Vancouver, BC, V6T 1Z3

2, 3, 4, 5, 6 Suite 106-1815 Kirschner Rd.Kelowna, British Columbia V1Y 4N7

ACCEPTED: 28 November 2017


early abstract:

Introduction: The High Acuity Response Team (HART) was introduced in British Columbia (BC) to fill a gap in transport for rural patients that was previously being met by nurses and physicians leaving their communities to escort patients in need of critical care. The HART team consists of a Critical Care Registered Nurse (CCRN) and Registered Respiratory Therapist (RRT) and attends acute care patients in rural sites by either stabilizing them in their community or transporting them. HART services are deployed in partnership with provincial ambulance services, which provide vehicles and coordination of all requests in the province for patient transport. This paper presents the qualitative findings from a research evaluation of the efficacy of the HART model, including staffing and inter-organizational functioning.  

Methods: Open-ended qualitative research interviewing was done with key stakeholders from 21 sites. Research participants included HART CCRNs, RRTs, administrative leads, as well as local Emergency Department (ED) physicians and nurses. Thematic analysis was done of the transcripts.

Results: A total of 107 interviews in 21 study sites were completed. Participants described characteristics of the model, perceptions of efficacy and areas for improvement. Rural sites reported a decrease in physician and nurse-accompanied transports for high acuity patients due to the HART team, but also noted challenges in delayed deployment, sometimes leading at adverse patient outcomes.  

Conclusions: The salient issues for the HART model were grounded in asomewhat artificial distinction between pre-hospital and inter-facility transport for rural patients, which leads to a lack of service coordination and potentially avoidable delays. A beneficial systems-change would be to move towards dedicated integration of high acuity transport services into hospital organizational structures and community health services in rural areas.