1. Transport of Critically Ill Patients Authors: Frank Dupont, MD, Michelle Johnson, MPH, Anne Pohlman, APN-CNS, Sam Ruokis, Team Background Evaluate and revise our policies for transport of critically ill patients (esp. A08-20 “Transporting and Monitoring Adult & Pediatric Patients within the Medical Center”) to ensure a clearly defined standard of care. Develop and implement transport workflow consistent with updated policy. Methods: Multidisciplinary team was established to review current policy. The team included: RNs from all ICUs, ICU MDs, ED, Anesthesia, Peri-Op, Transportation, Cath Lab, EP, Bronch Suite, GI, Radiology CT/IR/MRI, Respiratory Care Services, and clinical APNs. Team completed literature review and reviewed national guidelines. Team created diagram of the process for all critically ill patients: Neonatal, Peds, Adults, ED, Transfers in from Outside Hospital, Rapid Response Team, and Dr. Cart. Team determined minimum requirements for every transport and defined a process to determine stable and unstable patient status. Team received recommendations from ICU Local Practice Council and critical care services regarding consensus on flow, documentation, and implementation of policy. Team meet twice a month and reported to monthly Critical Care Committee. Team planned the implementation of recommended changes based on policy updates. Process Measures: Audit and review of new transport policy and workflow is contingent on updated documentation strategies currently pending Epic implementation. Process measures to track progress include: # of transports currently involving critically ill patients, # of transports without incident/safety events, time in which critically ill patients and staff are way from ICU, wait time to transport to test/procedure that again return to ICU, on time starts in OR and procedure areas, # successful transfer of care between ICU and procedure staff, # and type of safety events occurring while on transport. Aims Project Strategy Reason for Action: Caring for critically ill patients during transport outside the ICU is a high risk activity. We may not always have the right equipment which leads to potential safety risks or overburden/overuse of resources. Critically ill patients are transported throughout the hospital for a variety of reasons, but primarily for tests and procedures where it is important to optimize continuity of care. The transport policy in place did not reflect current practice. There was no standard of care across the 10 ICUs and other areas creating a challenging and highly stressful patient safety concern. Current practice and documentation strategies did not allow audit or review of success or failures during this frequent, challenging event. Transporting critically ill patients requires significant coordination between multidisciplinary groups and communication between these groups was poor. Alignment to UCM Strategic Priority : We must determine the right process for transport of critically ill patients to ensure that we provide highly reliable, defect-free care even when patients are travelling between clinical care areas. This is important because patients are extremely vulnerable during transport. Target Population: This will affect the transport of all critically ill patients. Changes Made Clear SOP for Transport of Critically Ill Patients with detailed responsibilities for each role created. Revised patient care policy (PC30) for critically ill patients based on administrative policy, A08-20 Transporting and Monitoring Adult & Pediatric Patients within the Medical Center. Policy was changed from administrative to patient care policy. New policy PC30 and SOP were approved by Medical Executive Committee for fall 2015 deadline. The new policy includes the transport of all patients throughout the medical center with clear attention to the high risk critically ill patients. New Transporting and Monitoring of Adult and Pediatric Patients within the Medical Center Cheat Sheet created to be used as a quick reference. Educational training checklists created for all team members involved in transporting critically ill patients. ICU to CCD 6 OR Transport Workflow flowsheets created for DACC, ICU RN, ICU Service, Pre-Op RN Function, and Surgery/EP Service. Created 24/7 pager list for all ICU services to ensure clear transfer of care and communication related to ICU transport/procedures. Lessons Learned This project serves as a great model for reviewing and assessing policies. Complex multidisciplinary projects require significant time and follow-up to assure buy-in and bring the project to completion. Workflows for ICU’s (pictured below) developed by the team are requiring a great deal of coordination from everyone on the team because too many places for system breakdown were identified. Next Steps Finalize RN Epic documentation for transport. Simulation of future state in preparation for go live. Implement process recommendations based on policy,PC30 ”Transporting and Monitoring Adult & Pediatric Patients within the Medical Center” updates. Go live pending Epic documentation completion. Educate staff on workflows for ICUs. Track/monitor. Critical Care Committee, MICU, ACC, DACC, Perfusion, Patient Transport, Neuro ICU, RCS, CTICU, PACU, QPI, SICU, EP, ICU RNs, ICU MDs, ED, Peri-Op, Cath Lab, Bronch Suite, GI, Radiology CT/IR/MRI, Respiratory Care, CCU, Burn ICU, Peds ICU, and Neonatal ICU Acknowledgements