Outreach Education

An outreach educational program should be a key component of all trans­port programs. The medical, social, and legal complexities of interfacility transfer of critically ill or injured neonatal and pediatric patients make fertile ground for continuing education activities.

When considering developing a transport program, it is imperative that the transport leadership team spend time marketing the program to the hos­pitals in the local community and meeting the medical directors and medical

Table 14.1: Objectives of Transport Outreach Education

• Ensure knowledge of basic stabilization principles for neonatal and pediatric patients

• Teach recognition of neonatal and pediatric illness that requires transfer to a higher level of care

• Delineate how to access the transport system and obtain consultation and recommendations for stabilization

• Upgrade understanding of the physiologic basis for initiating care and stabilization for the unique transport environment before team arrival at the referring facility

• Develop a system to provide follow-up information on patient progress and outcome (constructive advice about patient care at the referring facility is helpful)

• Arrange for seminars and other educational activities on topics relevant to transport (see Table 14.3 and Appendix E)

Table 14.2: Frequently Asked Questions About Outreach Education

1. Why should my transport program become involved in outreach education?

It gives transport team members an opportunity to meet and interact with staff from referring institutions with­out the added stress of a critically ill or injured neonate or child.

2. What are the important steps in developing an outreach program within your institution?

• First, the leadership of the transport program needs to understand the concept of outreach education and the benefit to the team.

• Next, consider your resources. Who on your team is trained, experienced, and excited about teaching? What specific “expertise” exists or is needed in specific topics, diseases, and management? Who has experience speaking to small and large groups? A transport team may first have to invest in its staff to prepare them for effective outreach (ie, development of a presentation, public speaking, comportment within a referring agency while not engaged in a patient transport).

• Once you have identified resources within your institution or program, you are ready to consider marketing outreach education.

3. Who should be involved in an outreach program?

Any and all members of the transport team, as well as staff within the hospital (emergency department [ED], pediatric and neonatal intensive care units [PICU and NICU]). Some institutions may have an outreach coordinator who will help with the logistics, contact institutions, set up activities, and perhaps be an active member of the educational team.

4. What should we do before our first outreach program?

• Start local and small. Consider your geographic location. Are there multiple transport programs in your area?

• What is unique about your program, and how can you best market your specialty?

• With the assistance of your public relations department, you may develop a marketing strategy.

• Now it is time to make the initial contact to these “targeted” institutions, clinics, and offices. Consider contact­ing the medical and/or nursing director of the department (eg, ED, NICU). Introduce yourself, and offer the services of your team for outreach education. Has this physician or nurse identified an educational need among staff? Was there a specific case that referring staff might like your team to present with patient follow-up and possibly “lessons learned” or how to better manage the patient until the transport team arrives?

5. What about the national certification/resuscitation courses? How are they a benefit to an outreach program?

Nationally recognized programs can be a definite asset to any outreach program. All of these programs offer continuing education units for participants, and many also offer a verification card that is valid for 2 to 4 years, depending on the curriculum.

Many hospitals offer some type of financial bonus for their staff who successfully complete the curriculum. In many areas of the country, there are not enough courses offered to meet the requests from staff. Many com­munity hospitals pride themselves market to their own community that 100% of their nurses on a specific unit (eg, ED, NICU) are certified in a particular area. These courses are another way for your transport staff to meet the need for staff education in community hospitals and clinics, which also can become a marketing tool for that community hospital. Most national courses require instructors to have taken the provider course and then an instructor course before being able to teach.

Table 14.2: Frequently Asked Questions About Outreach Education, continued

6.

• Measuring success depends on many factors. Ideally, we would all like to see improved care delivery and new and increased referrals from the hospitals that were targeted for outreach educational efforts. This, however, may be unrealistic, because not all neonates and children need the services of a transport team.

• Evaluation forms provide immediate feedback of the learners' perception of success of the teaching program.

• Knowledge change can be measured with a pretest and posttest design.

• Patient outcome may be measured by morbidity and mortality reviews before and after the educational offering.

• Before starting an outreach program, your team and institution may want to obtain baseline data about current referral patterns, potentially targeting other institutions that are not referring or do not often refer patients to your facility.

• Reevaluate after a specified timeframe (6-9 months) to determine whether there has been an increase in referrals from individual institutions or requests from new institutions.

• Your outreach program may be considered successful when your team is able to report that the staff at the tar­geted hospitals was able to better stabilize the condition of and prepare a neonate or pediatric patient for transfer.

• Success in outreach education also can be measured in the trust and professional relationships that are devel­oped over time between the transport team and community agency staff. Hopefully, when a critically ill or injured neonate or pediatric patient is admitted to their institution, the staff members will be able to manage the patient while they call your team for transport.

7. Why is it important to consider outreach educational activities to prehospital providers (emer­gency medical services [EMS] providers)?

There is a great need for neonatal and pediatric education in the prehospital setting. There is limited time devoted to neonatal and pediatric topics in any initial prehospital curriculum (basic life support [BLS], advanced life support [ALS]).

We know that neonatal and pediatric patients may have subtle manifestations of serious, even life-threatening conditions. Sharing your expertise with EMS providers will sharpen their assessment skills and teach them to take neonatal and pediatric patients to the right hospital at the right time.

8. What are the financial issues to consider with an outreach program?

• The financial commitment will vary depending on your program goals and plans. Some transport teams include participation in outreach education as one of the requirements to be on the transport team. In this environment, the transport budget may include time for individual team members to prepare and present outreach topics.

• The financial commitment also will depend on whether you have a dedicated educational coordinator as part of the leadership of your team.

• If you do not have outreach education as a requirement for your team members, your institution's mission statement might include an educational component or an expectation that staff will participate in some volunteer efforts.

• Your commitment might need to include paying staff salaries for preparation, time presenting the educational curriculum, and travel expenses.

• Individual transport programs and institutions also can be creative in supporting outreach educational efforts by offering incentives to members who assist in outreach education.

9. What is the benefit to the referring agency to participate in an outreach educational program?

Referring institutions and agencies benefit because they have the opportunity to learn from and ask questions of transport team members who have expertise in specific areas, diseases, and management.

Table 14.3: Sample Topic List for a Transport-Related Outreach Education Program

• General topics (eg, stabilization of the patient's condition for transport)

• Respiratory (eg, upper and lower airway disease, structural anomalies such as diaphragmatic hernia, tracheo­esophageal fistula)

• Cardiovascular (eg, shock, congenital heart disease, arrhythmias)

• Neurologic (eg, coma, seizures)

• Poisonings

• Trauma (accidental, nonaccidental, birth related)

• Metabolic (eg, diabetic ketoacidosis, congenital metabolic disorder)

• Hematologic-oncologic emergencies (eg, sickle cell crisis, primary and secondary hemorrhagic diathesis)

• Infection-related emergencies (eg, sepsis, meningitis)

• Renal (eg, renal failure)

• Surgical emergencies in addition to those involving the respiratory system

• Transport case reviews

• Management of accompanying and nonaccompanying family members

and nursing staffs of the emergency departments and inpatient pediatric and neonatal units. This initial contact not only introduces the team but also is an ideal opportunity to further assess the need for and offer outreach education.

An educational and training assessment, often part of a marketing sur­vey, permits targeting of necessary and sought-after (the 2 are not always the same) education and training activities. Developing relationships with department educators and clinicians will assist in determining institution­specific educational needs. An assessment of institutional resources should be included when developing teaching goals and needs. There are many types of educational offerings that may be of interest to referring hospital staff. Consider asking referring facilities what educational offerings they might desire or need. Methods of inquiry include direct written or verbal communication during marketing visits; conversations with staff; managers, educators, and physicians; and/or written surveys, with a checklist of specific courses or individual lectures or skills content that are areas of expertise for the transport team members. Transport teams should also consider the role and value of social media (eg, Facebook, Twitter, Flickr, etc) in all forms of outreach. Transport teams can also determine educational opportunities in a more informal setting through casual conversations with physicians, edu­cators, or individual staff members and when the transport team medical director and/or coordinator continue the marketing and public relations sessions with small groups at the referring centers. Post-transport follow-up phone calls, quality-improvement reviews, and identification of perceived deficiencies may direct the focus of education.

Informal discussions during initiation of transport, at the referring facility, and during the completion of the transport at the receiving facil­ity also can assist in determining the required and requested education and training from people who will be attending the training sessions and applying the information to the transport environment. When transport team staff members are approachable and referring facility personnel become more comfortable and develop relationships with the transport team, they are more willing to approach transport team members, ask ques­tions, and verbalize specific educational needs. Transport team members can gauge and influence the competency of referring personnel by partici­pating as instructors in formal certificated training programs (activities), such as Pediatric Advanced Life Support (PALS), Pediatric Education for Prehospital Professionals (PEPP), Advanced Pediatric Life Support (APLS), and Neonatal Resuscitation Program (NRP) courses (see Appendix F).

Many times, referring facility personnel are interested in specific lec­tures or a combination of lectures and psychomotor skill practice. Topics might include basic ABCs (airway, breathing, and circulation), prepara­tion and stabilization for transport, respiratory diseases, intravenous access with practice, conscious sedation, resuscitation, medication calculation and administration, management of diabetic ketoacidosis, management of sei­zures, pediatric assessment, and trauma. Faculty for this type of educational session can include a combination of physicians, nurses, and paramedics.

The need for well-prepared and experienced instructors is paramount. The initial impression of transport team members as out-reach educators can be a lasting one. Meeting the educational needs of many individuals also can be a challenge. As the transport team begins educational opportunities with individual health care facilities, the relationship with the team and the team's institution is strengthened. Transport teams should collaborate with their own marketing department in selecting specific promotional items bearing the team logo and contact information that can be distributed at educational sessions. These may include pens, pencils, key chains, note pads, posters, and drug dosage cards. One popular item is a small magnet, in the shape of an ambulance, with the team logo and contact information. Many referring facilities have magnetic patient tracking boards, and these magnets are used by the referring facility to “mark” transport patients when a transfer is in progress.