Kornelsen Jude, Hobbs Brent, Buhler Holly, Kaus Rebecca, Grant Kari, Lamont Scott C, Grzybowski Stefan
University of British Columbia, Vancouver, BC, Canada
Patient Transport Services, Interior Health, Kelowna, BC, Canada
Rural Remote Health. 2018 Jun;18(2):4316. doi: 10.22605/RRH4316. Epub 2018 Jun 12.
The High Acuity Response Team (HART) was introduced in British Columbia (BC), Canada, 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 article presents the qualitative findings from a research evaluation of the efficacy of the HART model, including staffing and inter-organizational functioning.
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.
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 to adverse patient outcomes.
The salient issues for the HART model were grounded in a somewhat artificial distinction between pre-hospital and interfacility 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.
加拿大不列颠哥伦比亚省（BC）引入了高 acuity 反应团队（HART），以填补农村患者转运方面的空白，此前这一需求由离开社区护送重症患者的护士和医生来满足。HART 团队由一名重症监护注册护士（CCRN）和一名注册呼吸治疗师（RRT）组成，通过在社区稳定病情或转运患者，为农村地区的急性病患者提供服务。HART 服务与省级救护车服务合作开展，后者提供车辆并协调该省所有患者转运请求。本文介绍了对 HART 模式有效性进行研究评估的定性结果，包括人员配备和组织间运作情况。
对来自 21 个地点的关键利益相关者进行了开放式定性研究访谈。研究参与者包括 HART 的 CCRN、RRT、行政负责人，以及当地急诊科（ED）的医生和护士。对访谈记录进行了主题分析。
在 21 个研究地点共完成了 107 次访谈。参与者描述了该模式的特点、对有效性的看法以及改进领域。农村地区报告称，由于 HART 团队的存在，高 acuity 患者由医生和护士陪同转运的情况有所减少，但也指出了部署延迟方面的挑战，有时会导致患者出现不良后果。
HART 模式的突出问题源于农村患者院前和机构间转运之间存在一定程度的人为区分，这导致服务协调不足以及可能避免的延误。有益的系统变革是朝着将高 acuity 转运服务专门整合到农村地区的医院组织结构和社区卫生服务中发展。
