Desai Saumil, George Kevin, McDonald Kylie, Timoney Alysha, Kelland Dahna, Barr Stephanie, Carroll Molly, Lockhart David, Peters Olivia, Cooper Matt, Davis Jonathan
Newborn Emergency Transport Services (NETS), Perth Children's Hospital, Nedlands, WA, Australia.
Neonatal Intensive Care Unit, Perth Children's Hospital, Nedlands, WA, Australia.
J Perinatol. 2025 Jul 23. doi: 10.1038/s41372-025-02354-6.
Neonatal retrieval networks have adopted time-centric quality metrics as Key Performance Indicators (KPI) for setting and comparing benchmarking standards. Quicker launch time (departure from base), an essential KPI, enables neonatal retrieval teams to rapidly provide higher-level care to sick infants. The Newborn Emergency Transport Services of Western Australia (NETS WA) facilitates neonatal transfers across largest global retrieval area necessitating quicker team launch times for urgent retrievals. NETS WA conducted a quality improvement (QI) study to quicken team launch times for urgent retrievals.
The smart aim was to quicken NETS WA team launch times on urgent retrievals to comply with the recent Australian New Zealand Neonatal Retrieval Network 2022 benchmark ( < 15 min). Secondary aims included impact of quicker launch times on "first look time" (time from decision to retrieve to presence at bed side) and "total retrieval time" (total time taken from the decision to transport until the handover of the patient at the receiving hospital).
This study was completed over two years in NETS WA. Urgent priority retrievals are 10-15% of total transfers (120-180/year).
Plan-Do-Study-Action (PDSA) cycles: 1. Immediate access to transport cots 2. Additional personnel 3. Pre-defined priority matrix 4. Direct communication strategies. Launch time, first look time and total retrieval time were gathered from an electronic retrieval database (REDCap). Data collection were done at baseline (January-May 2022), during PDSA cycles (June 2022-April 2023) and after last PDSA cycle (May-December 2023).
Times are expressed as median (interquartile range IQR) in minutes. Comparisons were made for all transports and for road and air transports separately. Launch times decreased from 35.5 (21.5-90.0) at baseline to 17.0 (11.0-37.0) minutes (p 0.0006) after the last PDSA cycle for all urgent priority retrievals. Launch times for road only decreased to 15.0 (10.0-20.0) minutes (p 0.009). First look time decreased from 85.0 (54.8-269.3) to 52.5 (30.5-152.3) minutes (p 0.008). Total retrieval time changed from 243.5 (135.8-395.3) to 182.0 (117.0-390.0) minutes (p 0.33).
Well-designed QI measures enabled NETS WA teams to quicken essential time-centric quality metrics for urgent priority neonatal retrievals.
新生儿转运网络已采用以时间为中心的质量指标作为关键绩效指标（KPI），用于设定和比较基准标准。更快的启动时间（从基地出发）是一项重要的KPI，能使新生儿转运团队迅速为患病婴儿提供更高水平的护理。西澳大利亚新生儿紧急转运服务（NETS WA）负责在全球最大的转运区域内进行新生儿转运，因此需要更快的团队启动时间以应对紧急转运。NETS WA开展了一项质量改进（QI）研究，以加快紧急转运的团队启动时间。
明智的目标是加快NETS WA团队在紧急转运中的启动时间，以符合澳大利亚和新西兰新生儿转运网络2022年的最新基准（<15分钟）。次要目标包括更快的启动时间对“首次查看时间”（从决定转运到抵达床边的时间）和“总转运时间”（从决定转运到在接收医院交接患者的总时间）的影响。
本研究在NETS WA历时两年完成。紧急优先转运占总转运量的10 - 15%（每年120 - 180次）。
计划 - 实施 - 研究 - 行动（PDSA）循环：1. 立即使用转运床；2. 增加人员；3. 预定义优先级矩阵；4. 直接沟通策略。启动时间、首次查看时间和总转运时间从电子转运数据库（REDCap）中收集。数据收集在基线期（2022年1月至5月）、PDSA循环期间（2022年6月至2023年4月）以及最后一个PDSA循环之后（2023年5月至12月）进行。
时间以分钟为单位表示为中位数（四分位间距IQR）。分别对所有转运以及公路和航空转运进行了比较。在最后一个PDSA循环后，所有紧急优先转运的启动时间从基线时的35.5（21.5 - 90.0）分钟降至17.0（11.0 - 37.0）分钟（p = 0.0006）。仅公路转运的启动时间降至15.0（10.0 - 20.0）分钟（p = 0.009）。首次查看时间从85.0（54.8 - 269.3）分钟降至52.5（30.5 - 152.3）分钟（p = 0. 008）。总转运时间从243.5（135.8 - 395.3）分钟变为182.0（117.0 - 390.0）分钟（p = 0.33）。
精心设计的QI措施使NETS WA团队能够加快紧急优先新生儿转运中以时间为中心的关键质量指标。
