Dedicatedhospitaltransportationdepartments

ESEARCH IN BRIEF
The increasing complexity of patient conditions and concerns regarding safe lifting and transport has led hospital administrators to establish dedicated departments to provide patient transportation services. Organizational structures, dispatch systems, and methods for evaluating transporters vary across institutions and are tailored to promote efficiency and effectiveness. The following brief profiles the operations of four patient transport departments at institutions of varying parameters. MAJOR SECTIONS
ASSOCIATE
Profile: Zone system effectively allocates orderlies for Profile: Electronic tracking system facilitates dispatching, improves staff efficiency Profile: Large pool of volunteers accommodates demand Profile: Fully centralized model allows for faster response times and efficient use of staff DEDICATED HOSPITAL TRANSPORTATION DEPARTMENTS: PROGRAM EXAMPLES I. INTRODUCTION AND OBSERVATIONS

Concerns for patient and volunteer safety have led many hospital administrators to develop dedicated
departments to provide patient transportation services. Such departments train staff to be capable of safely lifting and moving patients throughout the hospital for necessary transfers, tests, or discharges. Some hospitals have completely eliminated the use of volunteers for patient transports, while other institutions find that, with proper training, volunteers may still be utilized—though trained staff members are required for more complex patient cases. The following observations were gleaned from interviews with four supervisors of patient transportation services at institutions of varying sizes:
Observation #1—Variety of centralized and decentralized organizational structures exist.
The profiled institutions maintain diverse organizational structures for their patient transportation departments. Hospital size does not appear to be the determinate for one particular model, as both larger and smaller hospitals prefer various organizational structures. For example, hospitals profiled in Sections II and V differ in size by over 800 beds, yet administrators at both institutions have found that a strictly centralized organizational model in which transporters circulate through the hospital promotes optimal efficiency and timeliness of responses. Alternatively, hospitals profiled in Sections III and IV dedicate as many as half of their transporters to hospital units of high demand, as they believe this type of decentralized model allows for the most effective means of accommodating units’ needs for patient
Observation #2—Goals for transporters defined differently across institutions.
Measuring quality goals for patient transporters is important to tracking staff efficiency and can be used to
motivate timely call responses. Quality goals are measured differently depending upon the institution; administrators at the profiled institutions define quality targets for transporters in the following ways: Call-to-arrival on the requesting floor targets “Out-the-door” response targets (transporters must leave for a request within a specified amount These quality targets may be tracked through paper logs, but increasingly electronic tracking systems are implemented to provide a streamlined method for dispatching and monitoring transporter activity.
Observation #3—Electronic tracking systems facilitate coordination of patient
transporters.
Patient transportation departments are becoming more reliant on electronic tracking systems to improve
the use of the services and hold staff accountable to quality goals. The complexity of coordinating patient transporters is streamlined through the use of automated systems capable of accepting requests, dispatching assignments to transporters, and monitoring transporter activities. The availability of such systems can centralize requests for all support services at a hospital or be tailored to a specific department. The following sections of this report detail patient transportation departments at four hospitals of varying DEDICATED HOSPITAL TRANSPORTATION DEPARTMENTS: PROGRAM EXAMPLES II. PROFILE: Zone system effectively al ocates orderlies for patient transports
The hospital maintains a dedicated patient transport department for transporting both Institution type:
inpatients and outpatients. Transporters— also referred to as orderlies—are also throughout the hospital as needed. Hours of operation: Seven days per week, 24 hours
Percentage of
transports
orderlies complete 71,600 runs per month, completed by
80 percent of which are patient transports. employees:
Program attributes: • Centralized organizational
Centralized pool of orderlies
assigned to hospital zones based on
organizational structure in order to ensure However, the hospital is designated into four different geographic zones and orderlies are assigned to specific zones to enable effective utilization of staff. High priority zones—areas of higher demand and/or greater urgency of transport requests—have circulating staff that never leave those areas; however orderlies in area of lower demand can assist these zones if needed. Hospital census and demand is evaluated daily to determine the most effective staffing
Dispatch activity managed through an electronic system
Overall, patient transports are coordinated by an automated tracking system that administrators purchased
in August 2000. Hospital staff requiring a patient transport can automatically enter their request into the computer system, which is monitored by dispatchers or “leads.” Generally, three leads are staffed during the day and one lead works during the night shift. The automated tracking system allows leads to check if hospital staff have entered their request correctly, observe pending trips and average wait times, and monitor orderlies’ statuses to see if they are available. The automated system even manages dispatching to orderlies because staff call in to receive their assignments via the telephone. The system is considered essential to coordinating assignments for the approximately 80 orderlies on duty during the day shift and 40 orderlies working the night shift. Additionally, the electronic system allows hospital staff to place future requests. Since the patient transport department serves both inpatients and outpatients, staff members can arrange for patients to be picked up from the front of the hospital and delivered to the appropriate outpatient clinic for follow-up appointments. This feature has boosted employee satisfaction and allowed leads to plan for projected DEDICATED HOSPITAL TRANSPORTATION DEPARTMENTS: PROGRAM EXAMPLES Tracking system allows for monitoring of multiple response targets
Administrators use multiple quality measures to evaluate orderlies’ efficiency. The electronic tracking
system allows the manager of patient transport to monitor the elapsed time from when the call was placed to when the orderly receives the assignment and also the time it takes for the orderly to arrive on the requesting floor. The quality goal for response time from the call being placed to the orderly arriving on the floor is 10 minutes, while the call-to-completion goal is 20 minutes. Therefore, orderlies are given an average of 30 minutes to complete each run. Orderlies are expected to complete 2.5 trips per hour.
Success defined by effectiveness and satisfaction of staff
Administrators consider their transportation system successful as they meet the aforementioned quality
targets, but they are continuously working to improve patient, employee, and orderly satisfaction. A 2004 patient satisfaction survey resulted in the department receiving a 4.85 score out of a possible 5 for meeting patient expectations. Additionally, the department manager believes that if staff enjoy their jobs they will provide better service, so she works on monthly staff recognition and incentive programs to improve transporter job satisfaction. Awards include cash bonuses or cafeteria vouchers for completing an average number of trips per hour, for employees’ birthdays, and for when the nursing staff recognizes an orderly for providing exceptional service during a patient transport.
III. PROFILE: Electronic tracking system facilitates dispatching, improves staff efficiency
The hospital has maintained a dedicated transportation department for at least the Institution type:
equipment such as beds, wheelchairs, and machines and to transport laboratory (lab) specimens as needed. Administrators Hours of operation: Seven days per week, 24 hours
prefer the combination of a centralized and decentralized organizational structure to Percentage of
best meet the demand for patient transport transports
completed by
1,000 each day. Overall, the department is employees:
Program attributes: • Combination of centralized
staff of 40 are also four emergency medical technicians (EMTs) who transport patients to their homes or long-term care facilities when they are discharged from the hospital. will be training the patient transporters in the near future. Additionally, two volunteers are assigned to the transportation department to assist with the transport of laboratory specimens. Hospital volunteers are not authorized to move patients due to DEDICATED HOSPITAL TRANSPORTATION DEPARTMENTS: PROGRAM EXAMPLES Demand requires pool of circulating transporters and some dedicated to particular units
The following departments have dedicated transporters assigned to their unit:
• Computed Tomography (CT)—One transporter is staffed Monday through Friday from 9:00 a.m.
to 2:00 p.m. If demand is low, this staff member will join the circulating pool of transporters. • Emergency department (ED)—Two transporters are staffed 7:00 a.m. to 3:30 p.m. Additional
transporters will be utilized if demand necessitates. • ED x-ray room—One transporter is staffed from 8:00 a.m. to 12:00 p.m.
• Gynecology recovery room—Two transporters are staffed to move patients out of the unit from
• Operating room (OR)—Three transporters pick up patients going to the OR from
• OR recovery room—Two transporters are staffed to move patients out of the unit from
• Rehabilitation workout room—One transporter assists staff from 8:00 a.m. to 12:00 p.m.
From 6:00 a.m. to 2:30 p.m., there are 20 transporters staffed at a specific unit or circulating and dispatched as needed. From 2:00 p.m. to 10:30 p.m., 10 to 15 transporters are on duty. Those in circulation receive requests from the centralized dispatch office.
Centralized dispatch manages patient transport assignments
The hospital maintains one telephone number for the following support services:
Generally, three dispatchers staff the day shifts and one dispatcher works during the evening shift. Staff in units requiring transport will call the main telephone number and dispatchers will enter the request into the computer which logs a queue of pending and completed jobs. When transporters arrive to work, they dial into the phone system, which activates them in the computer system. As each transporter’s pager includes a tracking device, dispatchers can then monitor the transporter’s location and assign them jobs according to the urgency of the request or location. Once a job is completed, transporters call the system and are automatically informed of their next assignment.
Collaborative brainstorming yields efficiency improvement ideas
Quality goals for transporters are measured from time of the call to the completion of transport.
Therefore, transporters aim to respond and complete most transports within 19 minutes. For the ED, transporters are asked to complete requests within 15 minutes. In monthly department meetings, transporters discuss ways to improve accountability of staff and timeliness of responses. For example, the transporters recognized that the ED would benefit from an additional dedicated staff member and administrators followed their recommendation. Therefore, administrators feel their current organizational model is effective in providing quality, timely patient transport services. DEDICATED HOSPITAL TRANSPORTATION DEPARTMENTS: PROGRAM EXAMPLES IV. PROFILE: Large pool of volunteers accommodates demand with minimal paid staff
Institution type:
responsible for all patient transports and increase in the number of patients being Hours of operation: Seven days per week,
recognition by the nursing staff that certain patients require transport by skilled staff prompted hospital administrators to allocate Percentage of
transports
transporters. Since the director of volunteer completed by
employees:
transports, the newly formed transportation Program attributes: • Combination of volunteers
department was incorporated into that unit. The chief of nursing and the director of develop a job description and competency requirements for the hospital transporter employees in proper patient transferring and lifting procedures. Thus, the dedicated patient transportation department was formed to supplement, though not replace, the volunteer patient transport services.
Centralized and decentralized organizational structure allows for better customer service
The paid transport staff represent a centralized organizational structure in that they form a regularly
available pool of staff to assist in moving patients throughout the hospital facility as needed. These paid staff members have specialty training in CPR, body mechanics and proper lifting techniques, and infection control. Due to the increasing complexity of patient care and the number of gastric bypass surgery patients treated at the hospital, dedicated patient transporters are required to assist in moving certain individuals identified as “precaution patients.” Staff members are considered more appropriate than volunteers in these circumstances since they have additional training that allows them to more safely Since the establishment of the department, the number of FTEs has been increased from two to three dedicated transport employees to accommodate the growing demand. The only unit which does not utilize the dedicated patient transport department is the OR, which is staffed with aides responsible for a number of duties, including patient transportation. Additionally, administrators dedicate some volunteer transporters to certain hospital units. Volunteers are dedicated to the radiology department and the day surgery unit, as these departments have been identified as requiring additional patient transport assistance. Administrators have found that having individuals assigned to those units ensures a more timely response and overall better internal and patient customer satisfaction. As the hospital maintains a volunteer pool of approximately 740 volunteers, administrators estimate that on average volunteers complete 75 percent of total patient transports. Overall, the paid transporters complete approximately 40 to 50 runs per day, and volunteers complete 25 to 30 hospital discharges, 30 to 40 transports in the day surgery unit, and 60 to 70 trips in the ambulatory care unit. DEDICATED HOSPITAL TRANSPORTATION DEPARTMENTS: PROGRAM EXAMPLES Computerized system eliminates need for a dispatcher
Requests for patient transports can be entered into a computer system directly by the nursing staff.
The computer system then sends a text message to the transporters’ pager with the request. New employees unfamiliar with the paging system often phone the volunteer services directly and staff there will triage the request and enter the request into the computer if the patient is identified as requiring a transporter. Two transporters are usually staffed during weekday hours of operation, and the two staff members coordinate between themselves who will respond to the request as the computer sends pages to both transporters simultaneously. Transporters can contact each other with text messages via the pager, communicate in person, or speak via a hospital phone to decide who will respond to the call. Administrators have not found this to be an issue as the transporters communicate well with each other, are good at prioritizing calls, and ensure that requests do not go unanswered. Administrators are currently evaluating a computer system that would provide a centralized line and dispatch system for all transportation, housekeeping, and engineering requests; however, administrators are concerned that the reliance on a dispatcher role may slow the transporter’s call response times. Currently, transporters are held to a standard of responding to a call within five minutes of receiving the request—referred to by staff as the “out-the-door” target—and thus far they have been successful in meeting this target. Ultimately, a centralized request line could be more convenient for the hospital staff and provide an additional mechanism for recording call response times.
Transporter response times reviewed monthly
Currently, transporters track their call responses through a manual paper system. Transporters are
required to log the following information regarding each request to which they respond: • Type of transport requested—discharge, stretcher required, pick up from car • Comment card for staff to provide feedback Transporters are held to the five-minute target of responding to the call and usually arrive at the requesting unit within 10 minutes. The director of volunteer services reviews these records monthly to
Patient and employee satisfaction and cost savings define department success
Administrators believe that high quality customer service requires staff to not only make a good first
impression, but also to ensure that the last encounter that the patient has with a hospital representative is favorable. Transporters therefore take extra effort to ensure that patients depart on a positive note. Administrators feel the service is successful as both the volunteer and paid transporters receive affirmative feedback from employees and patients. Furthermore, the large volunteer staff allows hospital administrators to meet the demand for patient transports without having to hire additional staff, which provides significant cost savings to the institution. DEDICATED HOSPITAL TRANSPORTATION DEPARTMENTS: PROGRAM EXAMPLES V. PROFILE: Ful y centralized model al ows for faster response times and efficient use of staff
The patient transportation department has been in operation for at least the last I
nstitution type:
20 years. Volunteers were allowed to assist administrators felt that their risk of injury was too great. Now only staff members are allowed to transport patients. Additionally, Hours of operation: Monday through Friday,
responsibilities—have been added to the Percentage of
transports
completed by
employees:
members will work as transporters. Program attributes: • Centralized organizational
two and a half weeks of on-the-job training in body mechanics, lifting, and equipment maneuvering. Administrators estimate that transporters complete an average of 5,300
Centralized staffing structure considered ideal
Administrators prefer a centralized organizational structure for the patient transportation department as
they believe it allows for the most efficient utilization of transporters. A combination of centralized and decentralized organizational structure was piloted for two months, but was quickly discontinued. In the pilot program, each floor of the hospital was assigned a transporter, but unequal demand by different units led to some staff being underutilized and others being unable to effectively meet demand. This created an uneven workload as the centralized pool of transporters were essentially asked to respond to the same number of requests, but with a reduced number of floating transporters since more staff were now dedicated to hospital floors. Since this short-term trial, administrators have maintained a centralized pool of transporters and believe it facilitates quicker response times.
Central dispatch triages calls and issues assignments
All calls for courier services, patient transports, or other miscellaneous requests related to the department
are received through a central phone number. The supervisor and an additional dispatcher manage and assign incoming requests. Transporters are equipped with two-way radios and upon completion of a trip will call into the central office to receive their next assignment. Through this system, administrators can ensure appropriate triaging of calls and send the closest transporter to manage a timely response to requests. Administrators’ general target for transporters is to arrive at the requesting floor within 5 to 10
Customer satisfaction rates exceed set goals
After patients are discharged from the hospital, they are mailed a customer service feedback form that
includes questions to assess their satisfaction with a variety of the hospital’s services; one of the questions specifically asks how satisfied they were with the patient transport services. Administrators have set a goal of 92 percent satisfaction rate for the department, and have exceeded this by achieving a 94 percent DEDICATED HOSPITAL TRANSPORTATION DEPARTMENTS: PROGRAM EXAMPLES Furthermore, administrators believe the expanded staffing of the department reflects internal satisfaction and support of the patient transport services. When the supervisor was promoted in 2002, the department consisted of 10 FTEs and has expanded every year since then by two to three additional employees. The hospital’s administrative leadership understands the demand for and value of the service and demonstrates their support by approving the necessary staffing. Research Methodology
During the course of research, Original Inquiry staff searched the following resources to identify hospitals with dedicated transportation departments: Advisory Board’s internal and online (www.advisory.com) research libraries Factiva , a Dow Jones and Reuters company Internet, via search engines and multiple websites, including the following: American Hospital Directory (AHD) at www.ahd.com Based on leads generated from the sources above, researchers contacted administrators at hospitals with dedicated transportation departments.
Professional Services Note
The Advisory Board has worked to ensure the accuracy of the information it provides to its members. This project relies on data obtained from many sources, however, and the Advisory Board cannot guarantee the accuracy of the information or its analysis in all cases. Further, the Advisory Board is not engaged in rendering clinical, legal, accounting, or other professional services. Its projects should not be construed as professional advice on any particular set of facts or circumstances. Especially with respect to matters that involve clinical practice and direct patient treatment, members are advised to consult with their medical staffs and senior management, or other appropriate professionals, prior to implementing any changes based on this project. Neither the Advisory Board Company nor its programs are responsible for any claims or losses that may arise from any errors or omissions in their projects, whether caused by the Advisory Board Company or its sources. 1-JWQ28 2006 by the Advisory Board Company, 2445 M Street, N.W., Washington, DC 20037. Any reproduction or retransmission, in whole or in part, is a violation of federal law and is strictly prohibited without the consent of the Advisory Board Company. This prohibition extends to sharing this publication with clients and/or affiliate companies. All rights reserved.

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