O3322: Private Vehicle Transport for Interfacility Transfers to the Emergency Department Improves Efficiency without Compromising Safety

Purpose/Objectives: Private vehicle, as opposed to ground ambulance transport, has been identified as a viable option in the interfacility transfer of patients. There are many potential benefits including: enhanced efficiency, decreased costs, and improved patient and family experience. Of course, patient safety is paramount, so this option should only be considered in carefully selected patient populations. This quality improvement project endeavored to increase awareness and create safety guardrails to encourage the use of private vehicle transfers in appropriate patient populations. We studied the efficiency of the process, monitored its safety, and reviewed the subsequent ED visits.

Design/Methods: Patients were identified over an eight-month period, originating from ten referring hospitals within a one-hour radius of our Philadelphia hospital campus, who were transferred by ground ambulance or private vehicle with similar chief complaints/diagnoses. These included: abscess, dental emergency, dog bite, eye emergency, foreign body, fracture, laceration, and testicular torsion. Transfer time was measured as the time from transfer request until arrival at the Philadelphia hospital emergency department (ED); ED length of stay was measured as time from check in at the waiting room to final disposition from the ED. A series of automatic notifications informed the receiving physician and nursing team of the arrival, to support expedited rooming and assessment. Figure 1 outlines our transfer process for this project.

Results: As demonstrated in figure 2, for patients transported by private vehicle rather than by ambulance, there was a statistically significant decrease in the average time from initiation of transfer by the referring hospital, to arrival at the Philadelphia ED (90 min v. 167 min, p < 0.0001). For these same patients transported by private vehicle rather than ground ambulance, there was no significant difference in the amount of time these patients spent in the ED after arrival (287 min v. 312 min, p = 0.20). Additionally, no patients decompensated or had any adverse outcomes identified.

Conclusion/Discussion: Private vehicle transport was found to be both efficient and safe in our pediatric patient population. In carefully selected patients who are very unlikely to have clinical decompensation or need therapeutic interventions or respiratory/circulatory monitoring in an ambulance, private vehicle transport can be considered for interfacility transfer. While ambulance transfer is the default mode of transport, private vehicle transport is an option in select patients. These families should be counseled on the risks & benefits of private vehicle transport vs. ambulance. Best practice is to notify the receiving hospital, as well as give patient report. Arrival alerts further optimize the process. In addition to safety and efficiency benefits, future work can explore the cost benefits, as well as patient/family satisfaction with private vehicle transport.