Stanford Children’s Health develops innovative process for safely transporting patients during an emergency or crisis event

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“It’s an extremely valuable tool that we’ll hopefully never need,” said Ronald Cohen, MD

November 5 , 2014

In an emergency, hospitals need to be able to quickly and safely transport patients to other facilities, along with all the specialized equipment, such as ventilators and intravenous medications, which patients need. That can be a monumental task, particularly in the heat of a crisis.

“Before, in an emergency, nurses and doctors would have to commit a great deal of time to figuring out who needed what resources and what needed to be done,” said Ronald Cohen, MD, clinical professor of neonatal and developmental medicine at the Stanford School of Medicine.

Now, Lucile Packard Children’s Hospital Stanford has a new electronic medical records system that helps make this transfer process safer and more efficient in the event of a major crisis, such as an earthquake or power outage. The result? Caregivers have prompt access to a fully automated report that categorizes patients in terms of their specific needs – e.g., what types of IV medication they receive, whether they’re on ventilators or whether they need an ICU bed.

It’s all part of a Stanford-designed program called TRAIN (Triage by Resource Allocation for IN-patients). TRAIN represents a process to quickly determine what kinds of vehicles and equipment are necessary for continuous patient care during a crisis event, and makes it possible to easily communicate patients’ needs to other hospitals or command centers coordinating transfers. For instance, TRAIN helps the hospital determine if cars or vans are needed, how many ambulances or specialty transports are required, and even how many IV’s and ICU beds should be in place at the receiving facility.

“Now we can see exactly what resources are needed for each patient at all times. Should we have to evacuate, which we hope we never have to do, TRAIN puts us far ahead of the game in terms of keeping our patients safe during an incident,” said Brandon Bond, director of the Office of Emergency Management.

Under TRAIN, patients are assigned a color, with red designated for patients in critical condition. These patients need specialized transport, such as an ambulance or military transport, in addition to life-support equipment, such as ventilators and more than two intravenous drips for medication. For example, a premature infant with high blood pressure and tube in the throat would fall into the red category. TRAIN allows care teams to communicate the medical resource needs of this patient, as well as the severity of his or her condition, with a single word: RED.

On the other hand, patients marked with blue tags are considered stable and can be transported in a car or bus, without any specialized equipment.

TRAIN was first piloted in 2009 by Cohen, who tested it in premature infants in the neonatal intensive care unit. He then brought the idea in 2010 to Bond, who saw the benefits of expanding the program to the entire hospital. The question then: Would doctors and nurses have to implement and update the color-coding system manually, or was there some way of automating it? How they answered that question was the real game-changer.

In the years that followed, Bond and Cohen worked with doctors and staff from departments throughout the hospital to develop a triage algorithm—a step-by-step procedure through which a computer can automatically classify patients according to TRAIN’s simple color-coding matrix. With that in place, the automated protocol could easily extend to include any patient at Lucile Packard Children’s Hospital Stanford.

They assembled a team for the task, including Anna Lin, MD, clinical instructor of pediatrics; Kay Daniels, MD, clinical professor of obstetrics & gynecology; Stephanie Wintch, RN; and Kristine Taylor, RN.

“The team members worked off-hours to develop TRAIN,” Bond said. “It was a real grassroots effort.”

“Once we had the algorithm, we knew our electronic medical record could easily calculate the TRAIN classification,” Cohen said. “Most importantly, the calculation could be done in an instant, without any additional work from doctors or nurses.”

The recent implementation of a new electronic medical records system called EPIC throughout Stanford Children’s Health presented the perfect opportunity. A fully integrated health care software system, EPIC has made patient records easily accessible and up-to-date, as well as easy to share throughout the care process. Doctors and nurses record the condition of every patient in EPIC, with constant updates in real time. Having that kind of information readily available during an emergency is invaluable and helps ensure patient safety, Bond said.

“Now, the computer system automatically categorizes patients based on their needs and that report is always on-hand,” Cohen said. “This would take hours to do manually, but it’s now available instantly, 24 hours a day. It’s an extremely valuable tool that we’ll hopefully never need.”

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