Nurse-Paramedic Co-Responder Transfers

• Overall: co-responder model reduced escort demand/costs and improved coordination, workforce reliability, and Inter Facility Transfer (IFT) capture.
• Reduction in rural and remote nurse escorts - 20%; time out of facility - 49%; overtime - 48%.
• Taxi costs reduced (return nurse escort to sending facility): ~54% down (avg/month); taxi cost per escort ~43% down.
• Receiving sites (n=49): less need for escorts, better planning/communication/predictability (means = 4.0, majority agree).
• Improvements in QAS workforce reliability: shift capture - 48%; breaks 83%; extended shifts 55%.
• Increased IFT capture/coordination: activity from 448 - 967; acute share from 15.5% to 38%; earlier transfer timing; further gains with refined dispatch/scheduling.
• Top request (survey): extend hours/coverage (incl. overnight/24-7).

Interfacility transfers (IFTs) are a necessary but high risk phase of care: movement between facilities increases opportunities for clinical deterioration, equipment issues and communication failures, and therefore requires trained escorts, checklists and structured handover to mitigate risk (1). This aligns with evidence describing IFTs as complex, error prone processes requiring disciplined communication, risk mitigation strategies and crew training to ensure safety (1). Authoritative reviews further show that outcomes improve when transport is delivered by specialised, well- teams operating to standardised processes — reinforcing the case for defined roles, preparedness, and capability during transport and the importance of matching transport team capability with the clinical requirements of each transfer (2).

Within Queensland, mandated processes shape safe, timely and equitable transfers: consultant to consultant acceptance, pretransfer communication between referring and accepting facilities, and coordination with the Queensland Ambulance Service (QAS); for urgent or time critical transfers, Retrieval Services Queensland (RSQ) provides clinical coordination (3). These principles align with contemporary evidence that team composition, training, checklists, and standard operating procedures are central to safer IFTs and smoother patient flow across regional networks (4). Together, these frameworks emphasise the combination of local governance and evidence-based practice required for consistent safety in interfacility transport.

In Far North Queensland, rural and remote hospitals face distinct workforce pressures when ward nurses leave to escort patients, creating on ward capacity gaps, backfill costs and overtime; simultaneously, non-emergency IFTs can divert acute ambulance resources. Establishing a dedicated, multidisciplinary transfer team with clear scope and governance addresses these risks by keeping local nursing capacity in place and improving predictability and planning (1, 4). This approach is consistent with literature highlighting how dedicated transfer teams reduce workflow disruption and strengthen system resilience (4).

The IFT Nurse Co Responder Model, a joint CHHHS-QAS initiative that commenced Oct 2025,  was designed to operationalise these principles locally through an RN-QAS co responder crew with defined inclusion/exclusion criteria, integrated dispatch and standardised handover/documentation - directly reflecting the risk reduction and governance elements recommended in the literature and Queensland policy (1, 3, 4). The model focuses on scheduled/urgent non-emergency transfers, excludes clinically unstable/paediatric/obstetric/acute behavioural cases, and operates seven days on 12-hour shifts.  It also mirrors the structured team and standard process approaches identified as essential for safe transport in both state policy and national/international literature (2, 4).

Our early mixed methods preliminary evaluation explores whether this coordinated resource improves service efficiency and coordination while reducing workforce disruption and operational costs. The early CHHHS signals (reduced nurse escorts, time out of facility, and overtime) align with the evidence above and are mirrored by QAS operational data showing stronger workforce reliability (higher shift capture, better break compliance, fewer extended shifts) and greater IFT capture/coordination (more IFT incidents managed by the dedicated unit, a larger acute-IFT share, and earlier transfer patterns), reinforcing the value of embedding evidence-aligned processes and dedicated capability into interfacility transport systems (2, 4).

Enablers and context. Success hinged on a strong QAS-CHHHS partnership, single purpose IFT crews, clear inclusion and exclusion criteria, and integrated dispatch/governance processes that balanced clinical urgency with operational realities. Regular joint QAS-HHS meetings (Access and Redesign, Rural and Remote Services partners, and operational leaders) enabled continual iteration of the model and real time issue resolution. Ready access to documentation systems (ieMR/eARF), standardised handover processes, and co-branding supported clarity of roles and accountability.

What worked. The dedicated nurse–paramedic resource aligned with the model's intent by reducing ward nurse escorts and associated overtime, creating capacity on rural wards; taxi expenditure likewise decreased, reflecting fewer ad hoc returns and better planning. Receiving sites reported improved predictability and planning, consistent with more transparent scheduling and targeted communication. QAS operational data showed marked gains in shift capture, break compliance, and acute IFT capture by the dedicated IFT unit.

Lessons and limitations. Early data are promising but drawn from a short post period with some variability in pre period data; survey sample sizes, especially for providers/overseers, were small. The most frequent user request was extended hours/overnight or 24/7 coverage, suggesting opportunities to amplify impact through additional capacity and after hours coverage. Improvements to proactive status updates/estimated time of arrivals (ETA) could further enhance experience. These limitations mirror known challenges in early stage IFT model evaluations, where short post implementation windows may underestimate long term efficiency gains.

Scalability across Queensland Health. The co responder model is well suited to other HHSs with dispersed rural facilities where nurse escorts are common and IFT demand competes with acute ambulance patient transport activity. The model's standardised governance, clear scope, and dispatch principles support replication with local adaptation (e.g., hours, geography, escalation pathways).

Next steps. Extend the model past pilot phase and embed routine monitoring (escorts, time out of facility, overtime, taxi) with complete location breakdowns; prioritise expanded hours/coverage; strengthen proactive communication/ETA visibility; and complete a 12-month evaluation to confirm persistence of gains and inform BAU integration.

1. Firstenberg MS, Stawicki SP, Luster J, Yanagawa FS, Bendas C, Ramirez CL, et al. Interhospital Transfers: Managing Competing Priorities while Ensuring Patient Safety. In: Firstenberg MS, Stawicki SP, editors. Vignettes in Patient Safety - Volume 2. London: IntechOpen; 2017.

2. Galvagno SM, Jr., Sikorski R, Hirshon JM, Floccare D, Stephens C, Beecher D, et al. Helicopter emergency medical services for adults with major trauma. Cochrane Database Syst Rev. 2015;2015(12):Cd009228.

3. Queensland Health. Protocol for management of inter-hospital transfers. QH-HSDPTL-025-2:2021. 2021.

4. Wilcox SR, Wax RS, Meyer MT, Stocking JC, Baez AA, Cohen J, et al. Interfacility Transport of Critically Ill Patients. Crit Care Med. 2022;50(10):1461-76.

5. Bell D, McNaney N, Jones M. Improving health care through redesign. BMJ (Clinical research ed). 2006;332(7553):1286-7.

6. Prior SJ, Mather C, Miller A, Campbell S. An academic perspective of participation in healthcare redesign. Health research policy and systems. 2019;17(1):87.

Additional supporting internal documents

Evans L. NIFT Co Responder Evaluation - Executive Summary (v1.1), 23 Feb 2026. Cairns and Hinterland

Singh M, Abell C, Evans L. Interfacility Transfer (IFT) Nurse Co Responder - Model of Care (v1.1), 10 Oct 2025. QAS & CHHHS.