A Transport Pack for ICU Transfers QI Presentations – May 8, 2017 Chloe Ingoldby, CA-3    Josh Douin, CA-2    Vladimir Krepostin, CA-1

OR to ICU transfers can be: Tedious Risky                                                         Dangerous

Adverse Events are Common Incidence during transport of                Any Adverse Event: 22-68%                Serious Adverse Event: 4.2-31% Fanara et al, 2010

Serious Adverse Events - Cardiac Arrest - Severe Hyper- or Hypotension  - Arrhythmia - Hypoxia, Bronchospasm, PTX - Extubation - Death Minor adverse event "physiological decline of more than 20% compared to clinical status before transport, or problem due to equipment" Serious adverse events "put the patient's life at risk and require intervention" Fanara et al, 2010

Click to add text Fanara et al, 2010

Target Areas 1) Standardized Procedures / Personnel 2) Organization and Equipment 3) Checklists Personnel often implies skilled providers (i. e. MD's) accompanying RN's during transport.  This is less of an issue for trained anesthesia providers Checklists may be the next area of interset

Current Solution: Whatever you remember to grab

Uses existing ambu bag, existing ETT and disposable handle/blade

Emergency medications (requested by 96% of respondents)are net yet included due to:  1) Sterility and expiration concerns – per Dr. Seres 2)Cost Note Disposable blades/handles --> approximately 1/10 cost of traditional LED handles and blades ($120 vs. $14) Remainder of equipment is already purchased by the university 

Budget at UCH 2-3 laryngoscope LED Handles ($90 each) & blades ($30) go missing weekly Only 50% eventually return Department loses $120-$360 weekly  According to Russ Ingram,head Anesthesia Tech

Budget at UCH Disposable Handles/Blades ~ $7 each $14 total for Transport Pack (MAC 4 and MIL 2) Assuming lost handles/blades remain constant (2-3 per week), the Anesthesia Department will save $99-$360 per week $120-$21 = $99;  $360-$14= $346

References 1) Link J, et al. Intra hospital transport of critically ill patients. Crit Care Med 1990;18:1427-9 2) Beckmann U, et al. Incidents relating to the intra hospital transfer of critically ill patients: An analysis of the reports submitted to the Australian incident monitoring study in intensive care. Intensive Care Med 2004;30:1579-85. 3) Venkategowda PM et al. Unexpected events occuring during the transport of critically ill ICU patients. Indian J Crit Care Med 2014;18(6):354-7 4)Warren J, et al. Guidelines for the inter- and intrahospital transport of critically ill patients. Crit Care Med 2004;32:256-62 5) Liu J, et al. High incidence of adverse events during intra-hospital transport of critically ill patients and new related risk factors: a prospective multicenter study in China. Critical Care 2016;20(12) 6) Jiang X, et al. Safe transport combined with prospective nursing intervention in intra-hospital transport of emergency critically ill patients. Int J Clin Exp Med 2016;9(7):13166-13171 7) Fanara B, et al. Recommendations for the intra-hospital transport of critically ill patients. Critical Care 2010;14(R87) 8) Brunsweld-Reinders A, et al. A comprehensive method to develop a checlist to increase safety of intra- hospital transport of critically ill patients Critical Care 2015;19(214)