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Evaluation of Inter-Facility Medical Transport Journey Times in Southeastern British Columbia

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Evaluation of Inter-Facility Medical Transport Journey Times in Southeastern British Columbia Master Thesis in Geographical Information Science nr 52 Evaluation of Inter-facility Medical Transport Journey Times in Southeastern British Columbia Holly Buhler 2016 Department of Physical Geography and Ecosystem Science Centre for Geographical Information Systems Lund University Sölvegatan 12 S -223 62 Lund Sweden Holly Buhler (2016). Evaluation of Inter-facility Medical Transport Journey Times in Southeastern British Columbia Master degree thesis, 30/ credits in Master in Geographical Information Science Department of Physical Geography and Ecosystem Science, Lund University ii Evaluation of Inter-facility Medical Transport Journey Times in Southeastern British Columbia Holly Buhler Masters thesis in Geographical Information Sciences, 30 credits Supervised by: Paul Miller, Department of Physical Geography and Ecosystem Science, Lund University Brian Klinkenberg, Department of Geography, University of British Columbia iii Acknowledgements I would like to extend my heartfelt thanks to my family and friends for their encouragement and support during this project as well as to all of those who helped me in moving this project forward. To Jude Kornelsen and Stephen Grzybowski, directors of the Centre for Rural Health Research and Brent Hobbs of Interior Health: thank you for providing the vision and foundation for the larger programme of research in which this project was situated. In addition, many thanks to all of the HART clinicians and adminis- trators who supported the development and implementation of this research. This project would not have been possible without the support of my supervi- sors: Paul Miller at the Department of Physical Geography and Ecosystem Sci- ence, Lund University, and Brian Klinkenberg at the Department of Geography, University of British Columbia. Thank you for your invaluable guidance and feed- back. Finally, I would like to thank all of the dedicated health professionals who con- tribute to delivering inter-facility transport services to high acuity patients in Southeastern British Columbia. Your work truly makes a difference! iv v Abstract Very sick patients who need specialized health services often require transport from their community to a regional facility that is appropriately resourced to provide definitive care for their condition. This is particularly important for people living in rural and remote areas but can be challenging due to long distances, mountainous terrain and inclement weather. The purpose of this research was to improve health service delivery to rural commu- nities within the study area by identifying whether or not there were inter-facility medical transport routes within the study area with highly variable or unexpect- edly long journey times. Select transport characteristics were examined to further inform decision making related to acute inter-facility transport within the study area. The medical records of 418 high acuity patient transports within Southeastern British Columbia were reviewed in order to capture information about ‘observed’ transport times, locations, and other transport characteristics. A geographic net- work analysis of each route identified within the study dataset was conducted in order to estimate ‘expected’ transport times. These expected transport times, in addition to GoogleMap time estimates, were compared to observed transport times to determine areas of possible concern within the transport network. A multiple regression analysis was conducted to identify predictors of transport times. Observed transport times in the study dataset were generally found to be within a statistically acceptable range of expected transport time estimates. The only trans- ports with significantly longer than expected journey times were due to ‘meets’ in transport. Additional factors such as patients’ clinical categories, mode of trans- port, and max elevation en-route were predictive of transport times within the study context. vi Keywords: Geography, GIS, network analysis, inter-facility transport, patient transport, medical transport, high acuity, road network, rural health, Emergency Medical Services vii Contents Acknowledgements iv Abstract vi Abbreviationsx List of Figures & Tables xii 1 Introduction1 1.1 Motivation................................1 1.2 Study aim................................2 1.3 Research questions...........................2 2 Background3 2.1 Study area................................3 2.2 Patient transport within Interior Health...............6 2.3 Theoretical framework.........................8 2.3.1 Transport time intervals....................8 2.3.2 Factors affecting transport time................9 2.4 Application of GIS........................... 14 3 Methods 19 3.1 Data collection............................. 19 3.1.1 Sample selection........................ 20 3.1.2 Tool development........................ 21 3.1.3 Data abstraction........................ 21 3.2 Geographic analysis........................... 22 3.2.1 Road network analysis..................... 22 3.2.2 Raster analysis......................... 23 viii 3.3 Statistical analysis........................... 25 3.3.1 Descriptive statistics...................... 25 3.3.2 Heteroscedasticity........................ 25 3.3.3 Regression............................ 26 4 Results 29 4.1 Evaluation of transport times..................... 29 4.2 Variability of transport times..................... 32 4.3 Factors influencing transport times.................. 33 5 Discussion 37 5.1 Limitations............................... 40 6 Conclusion 41 Bibliography 42 Appendix A 48 ix Abbreviations ALS Advanced Life Support BLS Basic Life Support BC British Columbia CCT Critical Care Team CCP Critical Care Paramedic CDED Canadian Digital Elevation Data CTAS Canadian Triage and Acuity Scale DAD Discharge Abstract Database DEM Digital Elevation Model ED Emergency Department EKRH East Kootenay Regional Hospital ePCR Electronic Patient Care Record EMAS Emergency Medical Ambulance Service EMS Emergency Medical Service GIS Geographic Information Systems GP General Practitioner GPS Global Positioning System HART High Acuity Response Team HCCM Heteroscedasticity-Corrected Covariance Matrices HA Health Authority HSDA Health Service Delivery Area IH Interior Health IQR Inter-Quartile Range KGH Kelowna General Hospital KBRH Kootenay Boundary Regional Hospital LHA Local Health Area MAD Median Absolute Deviation x MD Medical Doctor NTS National Topographic System PRH Penticton Regional Hospital QI Quality Improvement REB Research Ethics Board RIH Royal Inland Hospital RN Registered Nurse RRT Registered Respiratory Therapist SD Standard Deviation UBC University of British Columbia xi List of Figures 2.1 Interior Health, British Columbia, Canada..............3 2.2 Interior Health demography and topography by Local Health Area.4 2.3 Road Network within Interior Health.................5 2.4 BC Highway winter road conditions..................6 2.5 Major time intervals in inter-facility transport............8 2.6 Theoretical framework of factors influencing observed transport time9 2.7 Analysis functions in ArcGIS Network Analyst............ 15 2.8 Network example............................ 16 3.1 Route analysis example: Salmon Arm to Kelowna.......... 23 3.2 Mosaic of DEM tiles over study area................. 24 3.3 Elevation profile example: Trail to Kelowna............. 24 4.1 Transport routes within the study dataset.............. 29 4.2 Distribution of difference between observed and expected transport times................................... 31 4.3 Distribution of residuals of observed versus expected transport times 33 List of Tables 3.1 Selection Criteria............................ 21 4.1 Transport times by percentile..................... 30 4.2 Summary of observed journey times by route............. 32 4.3 Regression results (ArcMap time estimates)............. 34 4.4 Regression results (GoogleMaps time estimates)........... 35 xii 1 Introduction 1.1 Motivation In 1984, Canada adopted the ‘Canada Health Act’—legislation that has set pri- orities for healthcare in this country over the last 30 years. This Act describes five pillars of health services delivery in Canada: Public administration, Compre- hensiveness, Universality, Portability, and Accessibility (R.S.C., 1985). However, with the established trend towards the regionalization of health services, ensuring accessible healthcare for people living outside of urban centres has become ever more challenging (Lin et al., 2002; Schuurman et al., 2006). Patient transport plays a vital role in providing accessible healthcare to a widely distributed population (Doumouras et al., 2012). Very sick patients who need specialized health services often require transport from their community to a re- gional facility that is appropriately resourced to provide definitive care for their condition (Grzybowski et al., 2011). Efficient and timely medical transportation services ensure that people in rural areas can access regionalized health services as quickly as possible (Schuurman et al., 2006). In a rural context, this type of ‘inter-facility’ transport often involves long dis- tances, mountainous terrain and inclement weather (Chanta et al., 2014). On top of the geographic challenges, the complexity of moving high acuity patients is com- pounded by the need to ensure that a clinician who has the skill level needed to safely monitor and maintain a patient’s clinical stability throughout transport is available to accompany the patient (Brayman et al., 2012). Time to
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