Original Research
High acuity rural transport: findings from a qualitative investigation
AUTHORS
Jude Kornelsen1 Associate Professor, Associate Professor *
Brent Hobbs2 RN, BSN, CNCC(c), Network Director
Holly Buhler3 MMedSc, MGIS, Regional Practice Lead, Research & Knowledge Translation
Rebecca Kaus4 B.A, CAPM, MBA, Project Lead and Business Analyst
Kari Grant5 CCHRA(c), Medical Affairs and Clinical Network Analyst
Scott C Lamont6 BSN, RN, CCRN, CFRN, Patient Care Coordinator, Kooteney Boundary HART
Stefan Grzybowski7 MD, Medical Doctor
AFFILIATIONS
1 University of British Columbia, Vancouver, BC, Canada
2, 4, 5, 6 Patient Transport Services, Interior Health, Kelowna, BC, Canada
3 Research Department, Interior Health, Kelowna, BC, Canada
7 Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
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.