Interior Health (IH) covers a vast mountainous territory in British Columbia with limited acute care services at the rural and remote hospitals and health centers. Traditionally, this area has been serviced by British Columbia Ambulance Service (BCAS) basic life support (BLS) ground paramedics, and a provincial critical care paramedic (CCP) air ambulance system. However, transportation within IH is challenged by long distances and severe winter weather, which affect flight conditions. When the air ambulance is unable to perform transport, the registered nurse (RN) and/or physician (MD) on duty in these communities has been required to transport acutely/critically ill or injured patients to a higher level of care, leaving these communities without health personnel for hours. As an alternative, IH has established flexible deployment High Acuity Response Teams (HART) comprised of critical care RNs and registered respiratory therapists (RRTs) based out of four regional hospitals. These HARTs help diagnose and treat evolving critical illness/injury at an earlier stage, and, because they are dedicated to inter-facility transport, the HARTs enable rural clinicians to remain on duty.
From its inception, HART has used a program of continuous quality improvement (CQI) as a foundation to monitor quality of patient care and performance benchmarks. CQI data and patient care audits are analyzed by the clinicians, medical directors, and program managers to identify opportunities to enhance service delivery, professional development, and operational efficiency. This paper describes the establishment, scope, operations, and utilization of HARTs within IH.