Changing Workflow to Provide Quality Care

Abstract

Background:

In April 2020, the Surgical Trauma outcomes committee discussed a case with some communication failures with anesthesia and prolonged handoff time with mechanically ventilated patients in the operating room (OR) holding area. The method at this time was the bedside ICU RT transported the patient to the OR holding area and gave the CRNA handoff report. This method was not patient focused and contributed to poor communication between anesthesia and ICU team. The patient was not receiving ICU level of care and effectively taking the RT away from other patients.

Methods:

From April 15 - May 31, 2020 data was collected on dayshift (7:00am – 7:00pm) for mechanically ventilated patients that were transported to the OR holding area by the respiratory therapist from the Surgical Trauma Intensive Care. The time started at the main OR desk where the patients name was verified before proceeding to the holding area. In the holding area is where report was given to the CRNA. The time was stopped as the therapist exited the main OR desk. All time was recorded by the clock at the main OR desk.

Results:

There were 57 patients total for 8 weeks of data collection. It was concluded that the average waiting time in the OR holding area was 16 min and 56 s. This time however does not include the time spent packing the patient up for travel, travel time to the OR, or the amount of time for the therapist to return to the ICU.

Conclusions:

It was determined that the CRNA coming to the ICU to pick up the patient would eliminate taking the RT away from the ICU and allow the respiratory therapist to have more time for patient focused care. The patient would also receive ICU level of care until being transported directly to the OR. Communication between anesthesia and the ICU team improved, as well as decreasing the prolonged handoff time. A standard of practice checklist was created for all intubated patients going to the OR. The OR would give a heads up call 30-60 min before arrival. The RT would be responsible for a full O₂ tank at the head off the bed with the Ambu bag connected with PEEP valve. A 10-min call before arrival the RT would be close by to give the CRNA report and switch from ventilator to portable O₂. If the patient requires FIO₂ >0.60 or PEEP >12 or I:E ratio > 1:1 / BiVent, the therapist is responsible for communicating with the provider if patient is stable for OR transport. We must continue to try different approaches to improve workflow to be able to provide quality care to our patients.