OperationsMoving along
Improving patient transport department efficiency
By Anthony Anitra
The patient transport department is one that is often overlooked throughout many medical centers. The efficiency of this department is vital in maintaining the integrity of each diagnostic testing area. If the transport department were consistently late in delivering patients to their scheduled tests, essentially all other testing departments would suffer as well as the Medical Doctors who ordered each procedure. Patients arriving late adversely affect the entire schedule for the day.
The department in question does not involve any vehicle other than stretchers and wheel chairs. This is the examination of the process of in-patients being transported within medical centers to various diagnostic tests performed in departments such as Radiology, MRI, and Cardiology. These tests are often scheduled and it is of prime importance that each and every patient arrive in a timely manner to continue the efficient flow of each department throughout the day. Late patients will negatively affect each testing department and this will cause a ripple effect for the remainder of the day. Tardy patients create tests that spill over into other scheduled times. This creates a situation in which patients are left waiting in an uncomfortable position on a stretcher or wheel chair while the previous test is completed.
Patients are in medical centers to receive treatment and ideally heal in a timely manner. Comfort is imperative in any healing process. A stretcher is not a comfortable place for the healthiest of us all. Imagine being stuck on one for a significant amount of time due to the fact that the previous patient arrived late and created a waiting line. This situation can and should be avoided at all costs and a significant amount of effort must be made to ensure this situation rarely happens. The transport process is one that is seemingly simple but is actually quite involved.
About the process
The process begins with a call being placed to the transport office from one of the patient floors informing the dispatcher of the patient's name, test being administered, and any equipment needed. A single transporter is then dispatched to the floor in question and the transport begins. When the transporter arrives on the floor they must then transfer the patient from the bed to the mode of transport depending upon whether or not the floor has already completed this process. If the patient is ready to be transported each transport time would be significantly less. The time it takes to transfer a patient from the bed to the stretcher usually takes approximately five to ten minutes. Furniture must be moved, the bed must be adjusted, IV pumps must be transferred, and other variables must be sorted out before the transporter and nursing assistant can physically move the patient to the mode of transport.
One problem that is often prevalent throughout medical centers is the lack of equipment such as stretchers and wheel chairs. This problem can be the main cause of long transports and the late arrival of patients for scheduled tests. If there were a way to create a central location for this equipment that the transport department could easily access at times when specific requests are made by patient floors, it would greatly eliminate the need to send a transporter on a search throughout the medical center. These searches waste much needed time that a transporter can be helping a floor transfer the patient from bed to mode of transport.
Another problem that often occurs within the transport process is the exchange of information between the floors and the transport department. Often times it is not the particular patient's nurse giving the information to the transport dispatcher which results in vague and incorrect information. Stretchers are extremely valuable and often times scarce and should only be used for a patient who needs them. Often times a floor will call the transport dispatcher requesting a stretcher when the patient would have been perfectly fine traveling in a wheel chair. In this case a stretcher is compromised for a significant amount of time until the patient has completed his or her test and has been returned to their room.
Often times a floor will inform transport that they have the mode of transport and are simply waiting for a transporter to arrive and aid them in transferring the patient. A transporter will then arrive on the floor and discover the floor does not have the mode of transport and be forced to search for a stretcher or wheel chair. This creates completely unacceptably long transport times that could have easily been avoided had the right information been exchanged from the outset of the process. One of the most important parts of any type of communication is to be as descriptive as possible while also being as concise as possible (Fulwiler, Richard D., 2005 September. Leadership and Communication Skills for the EHS Professional. Occupational Hazards, 67(9), 33-34,36-37).
 A typical patient transport process. |
Redesigning the system
One suggestion to redesign this process would be to institute a request system through an intranet which the majority of medical centers possess. This system would involve an order system similar to that involved in many restaurants which would lay out the patient's name and whatever equipment that might be desired. Developed first in Germany, a program called Opti-TRANS©, is a computer-based planning system that supports all parties involved in the transportation network including nurses, transportation staff, dispatchers, logistics managers, and financial controllers. The software is designed to support all phases of the transportation flow, including request booking, scheduling, dispatching, monitoring, and reporting (Hanne, T., Melo, T., & Nickel, S., 2009. Bringing Robustness to Patient Flow Management. Interaces , Vol 39, No. 3, pp. 241-255).
This system could be easily accessible to nursing and would allow for the direct exchange of information from the most reliable source possible. This process would involve a few points and clicks of a mouse as opposed to the possibility of being put on hold by the transport dispatcher during peak times. This would drastically improve both the information exchange as well as eliminate the call times and confusion that often results from a secondary source such as the Unit Clerk. Transporters would receive the information needed and would result in a well-prepared transporter arriving on each floor.
Transports should not take more than 15 minutes in total on most occasions. Each individual transporter must understand this and I believe this must be instilled into every area of the transport process to change the point of view and make the priorities known to everyone. It will be very difficult to change the perception throughout any medical center so I believe it must be done gradually using a Management by Objectives (MBO) strategy. It is defined as a system of evaluating subordinates on their ability to achieve specific organizational goals or performance standards and to meet operating budgets (Jones, Gareth R., 2007. Organizational Theory, Design, and Change (5th ed.), Pearson-Prentice Hall).
Specific goals and objectives must be established at every level of the hospital to make it known that the previous methods will not be acceptable anymore. Changing the entire organizational outlook on this area will be a difficult task to achieve but I believe it is realistically possible with a gradual approach and not a radical one. Transport could start with a staff meeting in which everyone gets on the same page and understands exactly what is expected of them. There is currently a very detailed logging system of transports that shows exactly when, where, whom, and how long each transport takes. In two week intervals each individual transporter could be evaluated on how long their respected transports take and then either praised or corrected for their improvement or failure (Odiorne, George S., 1972. Management by Objectives. Pittman Publishing Co.).
It is vital that all floors and departments understand the importance and teamwork that is needed to successfully transport patients efficiently and safely throughout any medical center. If a floor is seen to have been careless or non compliant with any of the new policies they should be corrected immediately. When better results are demanded, better performance is almost always the result. On the contrary, when there is little demand for results, workers become complacent and performance will be affected in a negative way almost always. While the demands and standards must be at a high level, they should not be expected to be corrected in a short period of time.
The reason most managers do not demand high performance from their workers is due to the fear of rejection from the subordinates. Asking workers to perform at a higher level brings with it the fear of rejection and resentment or dislike. By adopting the right techniques, managers could avoid confronting subordinates on performance expectations and asking them to produce much more than the managers estimated they were likely to give anyhow (Shaffer, Robert H., 1991. Demand Better Results-And Get Them. March-April http://harvardbusinessonline.hbsp.harvard.edu).
 An improved patient transport process. |
The physical transfer
The process of physically transferring a patient from their bed to mode of transport is one that can always be improved. The physical transfer is not a comfortable one by any means but it is vital that each transporter as well as every medical center employee understand the need for an emphasis on safety throughout this process at all times. Slide boards ensure that the process is as comfortable as possible as the piece of plastic creates a more smooth surface to slide the patient over on. Often times the patient will encounter friction from the mattress or bed sheets while being pulled over and it will irritate any bed sores or other ailments they might be experiencing. Also, patients who have been in bed for long periods of time often conform to their mattresses creating a large hump to pull the patient over. This makes the process extremely uncomfortable and puts a physical strain on the transporter and staff as well.
Slide boards could be considered the single most important piece of equipment when transferring patients onto stretchers. This simple piece of plastic creates a much more comfortable surface on which the patient slides onto the stretcher from. Patients quickly and efficiently transfer from the bed to stretcher with little resistance from sheets or mattresses.
Transferring patients who are ambulatory is a seemingly simpler process due to the fact that the patient can walk. This process must be approached with much caution and an equal amount of emphasis on safety as the transfer from bed to stretcher. Patients should be accompanied by two staff members when walking to a wheel chair and both staff members must be conscious of supporting the patient at all times in case of a slip or fall.
Overall, the transfer of patients from their bed to mode of transport is one that is contingent with the emphasis of teamwork throughout the process. The transport department cannot be solely responsible for the safe and efficient physical transfer. Floors must adopt this teamwork mentality and be willing to aid in the physical transfer to ensure the patients comfort and safety.
A vital operation
The transport department is one that is extremely vital to both the comfort and safety of the patients throughout a medical center. Patients are the most important component of any health care facility and require much care and compassion while receiving their treatment. It is of prime importance that the patient transport department be recognized as such an important part of any medical center. The efficiency of this sole department can potentially create a negative situation for each testing area. Patients who arrive late for scheduled tests negatively affect the schedule for the remainder of the day. Medical Doctors cannot provide the best possible care or diagnose each ailment to the best of their ability as a result of this lack of efficiency in most cases.
Medical centers must recognize the importance of putting forth the effort to ensure the safety of each and every patient throughout by providing a capable patient transport department. The efficiency of the department hinges on the efforts and capabilities of the employees and equipment provided to each patient transport department. Patient transport is truly one of the unsung heroes in every medical center.
Anthony Anitra, MBA, is head of the transport department at Good Samaritan Hospital Medical Center in West Islip, N.Y. He can be reached at aanitra26@yahoo.com.
