Improving patient care, one transport at a time
Graduate student Dr. Atsushi Kawaguchi is developing a decision-making tool that will revolutionize the critical care transport field
The phone rings at 1:16 a.m. A six-year-old girl in northeastern Alberta is critically ill and needs to be moved from her rural hospital bed to the Stollery Children’s Hospital’s Pediatric Intensive Care Unit (PICU). The PICU specialist answers the call and decides to send one of their two transport teams via ground ambulance. Within four hours, the girl is on her way to the Stollery but seems to be steadily improving. By the time she arrives, the specialized care provided by the PICU is no longer needed and she is instead admitted to the Stollery general ward for the night.
About 50% of the pediatric patients who are sent to the Stollery using the services of the PICU transport team do not need PICU-level care within 24 hours. Even though it costs around one million dollars each year to operate the two PICU transport teams in Alberta, that cost is more than offset by the quality care received during transport, which may also result in reduced hospital stays. The need for these specialized teams is growing along with Alberta’s population. That is why Dr. Atsushi Kawaguchi, a WCHRI Graduate Student, decided to use his time and energy to develop a PICU transport decision-making tool that will help physicians remotely assess patients and make stronger informed decisions based on the patient’s specific transport needs.
As part of the PICU transport team, Dr. Allan de Caen has been taking calls for over 20 years. “Right now, it all comes down to the gut reaction of the physician taking the call,” says de Caen. “We don’t have an objective, quantifiable approach that everyone can use when taking a call, so it ends up being a visceral reaction. This tool will provide an objective opinion that may save time, resources and, most importantly, give the patients the specialized treatment they need.”
Creating a tool that can assist with making such complicated decisions requires a lot of input from other groups. Kawaguchi has been working with various transport groups across the province including the Referral, Access, Advice, Placement, Information & Destination (RAAPID) team, Advanced Life Support (ALS) flight team, STARS Air Ambulance, emergency physicians and many more to make sure this system will address the needs of each group and be used by everyone in the field of emergency transport. “We are engaging these stakeholders so they understand what we are trying to achieve, and are incorporating their expertise and opinions into the final product,” says Kawaguchi.
Kawaguchi has been analyzing all of the PICU transport teams’ calls over the last 20 years to create a basis for the tool. The RAAPID team has provided audio records for him to analyze and add to the data to make the tool more comprehensive. Historical data acquired from these transport groups will allow the tool to evaluate transport needs based on each situation and provide recommendations to the physician making the transport decision.
The PICU transport decision-making tool could revolutionize the field of emergency transport here in Canada and across the ocean in Japan. “By helping Atsushi create this tool, WCHRI is advancing not only a provincial initiative for children but actually helping create the foundation for an impact around the world since Atsushi plans to return to Japan and become a national leader in pediatric critical care transport there,” says de Caen. “It’s visionary!”
Kawaguchi's research has been funded by the generous support of the Stollery Children's Hospital Foundation, through WCHRI.