Using Checklists to Improve Turnaround Times in Time-Critical Interhospital Transfers

Time-critical interhospital transfer is operationally and clinically high-stake. Variation in referring-hospital preparation can prolong in-hospital turnaround time and delay definitive care. In 2022, time-critical interhospital transfers accounted for 1.5% of cases attended by a UK Helicopter Emergency Medicine Service (HEMS) organisation. Twenty-three patients were transferred, including 3 children. Our key performance indicator (KPI) of hospital turnaround time being less than 45 minutes was achieved in only 12 transfers (52%).

A UK HEMS organisation that undertakes time-critical interhospital transfers from district general hospitals to regional tertiary centers.

Two checklists (referring-team "Pre-arrival" and transport-team "Pre-departure") were developed. High-fidelity simulated time-critical transfer scenarios were undertaken in a simulation suite to improve crew familiarity before their introduction. The checklists were introduced into operational practice, and a post-intervention retrospective service evaluation of all interhospital helicopter transfers between January 1, 2024 and December 31, 2024 was then performed using routinely collected operational data (turnaround defined as landing-to-departure time at the referring hospital).

In simulated scenarios, the < 45-minute turnaround KPI was consistently achieved. In 2024, after the introduction of the checklists, 11 interhospital transfers were completed by air (2 paediatric), representing 0.6% of all missions. The < 45-minute turnaround KPI was achieved in 7 (64%) time-critical transfers. Fisher exact test showed that the difference in KPI achievement did not reach statistical significance.

Checklist-supported preparation may improve the reliability of meeting time-critical transfer KPIs while maintaining safe transfer standards. Owing to the relatively rare occurrence of these transfers, the absence of statistical significance should not be interpreted as an absence of a clinically meaningful effect. In routine practice, performance was influenced by outlier delays, suggesting a focus on reducing variability and embedding consistent pre-arrival preparation at referring sites.