Prepatching Reduces Paramedic In-Hospital Time for Emergent Interfacility Transfers of Patients Requiring Mechanical Ventilation or Vasopressors: A Retrospective Cohort Study

Objective: Regionalization of specialty medical services may necessitate an interfacility transfer. Prepatching is a model of care adopted by critical care transport organizations to reduce the transfer time to specialty care. In this model, paramedics communicate with a transport medical physician before arrival at the sending hospital to discuss a patient's condition and management plan, allowing paramedics to focus solely on packaging the patient when he or she arrives at the sending hospital. The objective of this study was to assess the impact of prepatching on paramedic in-hospital time for emergent interfacility transfers of patients requiring mechanical ventilation or vasopressor support.

Methods: This is a retrospective cohort study of all emergent interfacility transfers by Ornge, the provincial critical care transport organization in Ontario, Canada, over a 4-year period. All patients over 18 years old who were either intubated or on vasopressor medications were included in the study population. Quantile regression was used to evaluate the impact of prepatching as well as patient and paramedic characteristics on paramedic in-hospital time.

Results: A total of 4,466 emergent interfacility transports were included. Of these, 1,898 were completed with prepatching, and 2,568 were not. Vasopressor use was associated with significantly higher prepatching rates. Overall, prepatching reduced in-hospital time by 9 minutes at the 90th quantile across all patients. Increased in-hospital time was noted for patients on mechanical ventilation, on vasopressor medications, and transported by a fixed wing vehicle by 38, 29, and 49 minutes at the 90th quantile, respectively (P < .05). Conversely, patients transported by a critical care paramedic crew configuration were associated with a 27-minute decrease in in-hospital time at the 90th quantile compared with transport by an advanced care paramedic crew configuration (P < .05).

Conclusion: Prepatching reduced paramedic in-hospital time for emergent interfacility transports for patients who were mechanically ventilated or require vasopressors. These results suggest that prepatching can reduce the overall time to definitive care in high-risk patients, potentially improving patient outcomes in critically ill patients.