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

2. OR to ICU transfers can be:
Tedious
Risky
                                                       
Dangerous

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

4. 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

5. Click to add text
Fanara et al, 2010

6. 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

7. Current Solution: Whatever you remember to grab

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

12. 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 

13. 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

14. 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

15. References
1) Link J, et al. Intra hospital transport of critically ill patients. Crit Care Med 1990;18: ) 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: ) Venkategowda PM et al. Unexpected events occuring during the transport of critically ill ICU patients. Indian J Crit Care Med 2014;18(6): )Warren J, et al. Guidelines for the inter- and intrahospital transport of critically ill patients. Crit Care Med 2004;32: ) 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): ) 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)