Critical Care Transport Service in Washington State Streamlines Care Following AHRQ-Funded Grant

Funding from AHRQ has been influential in helping health care providers share best practices for how to deliver safe and high-quality patient care in Washington State. The project at the Rural Health Quality Network, a consortium of 37 hospitals across the state of Washington, sought to show how the use of health information technology could advance quality in a rural health care setting.

The AHRQ-funded grant provided tools in the form of Internet access and medical reference Web sites, allowing member hospitals of the network to look outside the local medical community or region for high standards of care. In doing so, Lincoln Hospital in Davenport, Washington, discovered the work of Abbott Northwest Hospital in Minneapolis. Abbott had pioneered development of the "Level 1 Protocol"—considered a best practice for percutaneous coronary intervention (PCI), a critically timed endeavor that sees a patient from a rural emergency room door to the catheter lab in 90 minutes or less.

Interested in what Abbott Northwest Hospital had achieved, Lincoln Hospital officials invited Northwest MedStar and Providence Sacred Heart Medical Center & Children's Hospital to visit Minneapolis and learn about the program. Impressed with what they saw at Abbott, the eastern Washington team decided to implement the protocol.

According to Rachel Zamora, RN, Clinical Services Manager for Northwest MedStar, a critical care transport service with bases in Spokane and Richland, Washington, "As a result of the grant to the network, Northwest MedStar developed strategies to decrease the total time to PCI. We redesigned our dispatch protocols, patient-handling techniques, and our land-to-lift procedures."

Northwest MedStar uses airplanes, helicopters, and ambulances to transport very ill or severely injured patients from rural community hospitals to definitive tertiary level care at Spokane's medical centers.

Zamora says the collaborative efforts to streamline internal processes—from early recognition to stabilization and transport at both the referring facilities and the receiving hospitals—have greatly reduced transfer times. "Northwest MedStar alone was able to decrease bedside time by almost 50 percent. We set a threshold of less than 10 minutes at the bedside and have continued to meet that goal with an average of 7.8 minutes during 2008. Every minute saved is heart muscle salvaged!"

After adoption of the Level 1 protocol—which involved making changes in workflow, care processes, and staff training—the Rural Health Quality Network and its partners educated consumers about how to recognize the symptoms of a heart attack. The importance of getting to a local rural hospital emergency department expeditiously was emphasized.

Zamora concludes, "This sophisticated and multi-tiered approach to improve the standard of health care for citizens living in rural areas is an example of what can be accomplished when dedicated professionals keep the patient at the center of collaborative decisions... always asking, 'Is this the best decision for the patient?'"