O2179: Improving Situational Awareness During Neonatal Interfacility Transport – A Simulation Study

Background: Neonatal interfacility transport in America’s pacific northwest region involves a complex system of communication between multiple stakeholders. The Transport Team (TT) is the only stakeholder group with visibility of the patients, or knowledge of their current condition while they are enroute. Medical Control Physicians (MCPs) and receiving teams rely on TT descriptions for care recommendations and enroute communication. Communication, and subsequent decisions, are primarily completed through phone calls or text messages. Teletransport applications help facilitate communication but must be studied for utility.

Methods: The study investigators, with input from transport stakeholders, co-designed a high-fidelity simulation of a Teletransport Monitoring and Communication (T-MAC) mobile application that organizes data from a variety of sources. Sources include near real-time vitals, location, video & audio streams of patient, patient electronic medical record, and streamlined voice and text communication. Two neonatal transport scenarios featuring newborns with neurologic and surgical conditions included time pauses for situational awareness questions on participants’ Perception of the patient condition, Comprehension of how best to respond, and Projection of what will happen next. Figure 1. The scenarios were conducted separately with MCPs and TT members using the T-MAC application for one scenario and standard practice (phone communication) for the other, randomly controlling for order. MCP scenarios were set remotely from the simulated patient, while TT’s were set at the patient bedside and ambulance.

Results: A total of 33 (20 MCPs and 13 transport) team members participated. In simulations with the T-MAC, MCPs had higher situational awareness scores across multiple domains of Perception, Comprehension and Projection (p < 0.05) while TTs had higher mean Perception scores (3.92 TMAC vs. 3.23 control, p=0.02) and a trend towards higher Comprehension scores (1.77 TMAC vs. 1.23 control, p=0.068) only at the initial assessment. Figure 2.

Conclusion: Use of teletransport applications such as the T-MAC may increase situational awareness of adverse events on neonatal transport. Although the app may improve initial perception of transport team members, use by remote providers may show the greatest benefit.