Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Transport of Critically Ill Patients by the Anesthesia Versus the Intensive Care Unit Service: A Before–After Study of Operating Room Workflows

Dupont, Frank W. MD*; Tung, Avery MD, FCCM*; Shahul, Sajid S. MD, MPH*; Pohlman, Anne MSN; Joseph, Silas MD*; Gottlieb, Ori MD*; O’Connor, Michael F. MD*; Cutter, Thomas W. MD*

doi: 10.1213/ANE.0000000000004223
Perioperative Medicine: Original Clinical Research Report
Buy
SDC

BACKGROUND: We implemented a new policy at our institution where the responsibility for intensive care unit (ICU) patient transports to the operating room (OR) was changed from the anesthesia to the ICU service. We hypothesized that this approach would be associated with increased on-time starts and decreased turnover times.

METHODS: In the historical model, intubated patients or those on mechanical circulatory assistance (MCA) were transported by the anesthesia service to the OR (“pre-ICU Pickup”). In our new model, these patients are transported by the ICU service to the preoperative holding area (Pre-op) where care is transferred to the anesthesia service (“post-ICU Transfer”). If judged necessary by the ICU or anesthesia attending, the patient was transported by the anesthesia service (“post-ICU Pickup”). We retrospectively reviewed case tracking data for patients undergoing surgery before (January 2014 to May 2015) and after implementation (July 2016 to June 2017) of the new policy. The primary outcome was the proportion of elective, weekday first-case, on-time starts. To adjust for confounders including comorbidities and time trends, we performed a segmented logistic regression analysis assessing the effect of our intervention on the primary outcome. Secondary outcomes were turnover times and compliance with preoperative checklist documentation.

RESULTS: We identified 95 first-start and 86 turnover cases in the pre-ICU Pickup, 70 first-start and 88 turnover cases in the post-ICU Transfer, and 6 turnover cases in the post-ICU Pickup group. Ignoring time trends, the crude proportion of on-time starts increased from 32.6% in the pre-ICU Pickup to 77.1% in the post-ICU Transfer group. After segmented logistic regression adjusting for age, sex, American Society of Anesthesiologists (ASA) physical status, Sequential Organ Failure Assessment (SOFA) score, respiratory failure, endotracheal intubation, MCA, congestive heart failure (CHF), valvular heart disease, and cardiogenic and hemorrhagic shock, the post-ICU Transfer group was more likely to have an on-time start at the start of the intervention than the pre-ICU Pickup group at the end of the preintervention period (odds ratio, 11.1; 95% confidence interval [CI], 1.3–125.7; P = .043). After segmented linear regression adjusting for the above confounders, the estimated difference in mean turnover times between the post-ICU Pickup and pre-ICU Transfer group was not significant (−6.9 minutes; 95% CI, −17.09 to 3.27; P = .17). In post-ICU Transfer patients, consent, history and physical examination (H&P), and site marking were verified before leaving the ICU in 92.9%, 93.2%, and 89.2% of the cases, respectively. No adverse events were reported during the study period.

CONCLUSIONS: A transition from the anesthesia to the ICU service for transporting ICU patients to the OR did not change turnover times but resulted in more on-time starts and high compliance with preoperative checklist documentation.

From the Departments of *Anesthesia & Critical Care

Pulmonary & Critical Care Medicine, University of Chicago, Chicago, Illinois.

Published ahead of print 09 April 2019.

Accepted for publication April 9, 2019.

Funding: None.

Conflicts of Interest: See Disclosures at the end of the article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

Reprints will not be available from the authors.

Address correspondence to Frank W. Dupont, MD, Department of Anesthesia & Critical Care, University of Chicago, 5841 S Maryland Ave, MC 4028, Chicago, IL 60637. Address e-mail to fdupont@dacc.uchicago.edu.

Copyright © 2019 International Anesthesia Research Society
You currently do not have access to this article

To access this article:

Note: If your society membership provides full-access, you may need to login on your society website