PMC:28995 / 17543-27585 JSONTXT

{"project":"2_test","denotations":[{"id":"11056703-7622953-23531788","span":{"begin":161,"end":162},"obj":"7622953"},{"id":"11056703-2245620-23531789","span":{"begin":1052,"end":1053},"obj":"2245620"},{"id":"11056703-7622953-23531790","span":{"begin":4723,"end":4724},"obj":"7622953"},{"id":"11056703-1433406-23531791","span":{"begin":4895,"end":4896},"obj":"1433406"},{"id":"11056703-1433406-23531792","span":{"begin":5109,"end":5110},"obj":"1433406"},{"id":"11056703-7622953-23531793","span":{"begin":8125,"end":8126},"obj":"7622953"},{"id":"11056703-7587230-23531794","span":{"begin":8127,"end":8128},"obj":"7587230"},{"id":"11056703-2302952-23531795","span":{"begin":8129,"end":8130},"obj":"2302952"},{"id":"11056703-3135417-23531796","span":{"begin":8131,"end":8133},"obj":"3135417"}],"text":"Discussion\nIntrahospital transport involves significant utilization of resources, personnel time and interruption of care delivered to a critically ill patient [5]. This study examined the utilization of these resources and the amount of time required to safely transport a patient to an in-hospital diagnostic test or procedure. The traditional means of transport was compared with a new self-contained device, the CarePorter, with in-room and transport capabilities. The use of the CarePorter device required less resource personnel to safely transport the patient to a diagnostic test or procedure when compared with current intrahospital transport. This decrease in personnel did not result in a decrement in care, or an increase in patient or staff injury in the CarePorter group. This decrease in utilization of resources is of paramount importance in an era of medicine where increased pressures to reduce cost are ever present.\nIn response to complications that occur during intrahospital transport, Link et al designed a mobile transfer unit [2]. This could be attached to the patient's bed to provide power and gas for continuous treatment and monitoring of patients during transport. The system was designed in an effort to decrease changes in patients' level of care during transport and prevent complications. Since the introduction of the transfer unit for the study they experienced no unanticipated problems during intrahospital transport. This study supports the concept of the CarePorter device in providing streamlined patient care during transport, but did not address the savings in resource utilization.\nTime, equipment and personnel are needed to transport a patient. The amount of time involved of the bedside nurse to ready a patient for transport includes the coordination of the equipment needed, such as the emergency drug bag, portable electrocardiographic monitor, portable O2 saturation monitor and/or defibrillator, portable suction, and other equipment specific to the patients' needs. This must occur without compromising care to the patients assigned to the nurse. Not only does the equipment need to be readied, but also the patient must be prepared. This preparation includes psychological support to the patient and possible transfer to a stretcher. We found that there was no significant difference between the amount of time taken to ready a patient in each group. However, those patients who were transferred to a stretcher required on average an extra 21 min to ready. This time was direct time away from patient care. If the number of patients in this study were greater, the CarePorter group may in fact have demonstrated a statistical advantage in the time necessary to ready the patient for transport.\nThe location of the test site in relation to the ICU and the availability of the elevator determine transit time to a test site. Despite the perception that transit time is lengthy, it was surprisingly short, and did not depend on the mode of transport. Thus, the CarePorter device did not take longer to maneuver in and out of difficult areas such as elevators, which is a current criticism of the specialty bed and the reason that the patient is moved to a stretcher for transport.\nOnce the patient has returned to the SICU, he/she must be returned to pretransport status. This includes, but it not limited to, re-attaching the patient to the in-room monitoring system, arranging the iv pumps and poles straightening iv lines, straightening and or changing sheets, and the placement of drains to suction. All transported patients underwent this procedure; however, the amount of time required to return the patient to his/her baseline status was significantly different among groups. The average recovery time for the SB group was 22 min because time and personnel were required to transfer a patient back to the specialty bed from the stretcher. This action alone poses many risks to the patient, including extubation, discontinuation of lines and general discomfort, not to mention the possibility of back strain to the staff. The S group required 17.8 min to return the patient to his/her baseline status whereas the CP group required only 10.7 min. Because the pumps and ventilator were attached to the patient's bed, a simple disconnection of the device from the bed occurred. Thus, between 7-12 min per transport was saved during the return to baseline. This saving in time also improves the quality of care delivered to both the transported patient and those remaining in the ICU.\nDepending on the acuity of the remaining patients in the unit and the responsibilities of those individuals covering patient care, nurses were not always able to complete routine care [5]. The transporting nurse must, therefore, assume this care upon return to the unit. This increase in workload of the remaining staff nurses may lead to increased stress [7]. The issue of care of the remaining ICU patients is critical. Unless a qualified outside team transports the patient to the test, leaving the staff nurse in the unit, the care of the other patients is affected [7]. Though we did not find a difference between the modes of transport with respect to the care of the patients remaining in the unit, any modality that decreases time taken arranging and conducting the transport is beneficial.\nThe nurses' satisfaction with the overall transport was greater with the CP group. Nurses were more satisfied because the device was easy to maneuver, all additional equipment was attached, there were no iv pole(s) to push and there was no need for manual ventilation. Coupling and uncoupling the device prior to and upon return to the SICU was easy and required minimal time. The patient was returned to baseline status more quickly and overall the CarePorter made the transport easier. Since intrahospital transport is a source of angst among staff, anything that can reasonably improve this process is warranted.\nSince all patients were mechanically ventilated in this study the respiratory therapist was not included in calculating the number of transporting personnel. However, significant reductions in overall respiratory time were seen with the use of the CarePorter device. On average, 20 min of respiratory time per transport could be saved with the use of the CarePorter device. Since in a unit the number of intrahospital transports ranges from one to 10 per week (average of three), this could result in significant savings of respiratory therapy personnel time. However, unless the nurse assumes responsibility for connecting the air/oxygen tanks to the wall supply, the respiratory therapist would still need to accompany the patient to and from the test site. This task is simple, but would require additional education.\nIn addition to reducing respiratory therapy personnel time, the CarePorter provided a saving of one person per transport, with the overall time for transport of about 40 min for the standard bed, with an additional 40 min for transport of the specialty bed/stretcher group. Thus, savings of escort personnel would occur when a large number of transports are needed. The financial impact of this transporter depends on the standards for transport at a particular institution, and the number of transports of mechanically ventilated patients. The reductions in nursing time are more difficult to report in terms of actual cost savings for the unit because the workload of the transporting nurse is shifted to nurses remaining in the ICU. Improved efficiency is the expected outcome rather than reduced cost, with care that would not be provided because the transporting nurse was not present for a certain period being minimized as time away from the unit decreases.\nThe issue of patient and staff safety is important throughout the hospitalization, irrespective of the patient's location. Although every effort is made to prevent such incidents, inadvertent discontinuation of iv catheters, drains and iv fluid does occur during transport. Reports of these occurrences vary depending on data collection definitions for transport related complications [5,8,9,10]. There is also potential for minor staff injuries to occur during pushing the patient and equipment to the test site. In this study minor injuries occurred irrespective of the patient group. The advantage of the CarePorter should be that as all equipment is attached to the patient's bed and moves as one unit, the risk of injury is reduced; however, this may be offset by the fact that the CarePorter is a heavier device.\nThis study was a prospective trial of transports that occurred over a 3-month period. Randomization of patients was affected by a variety of factors including the presence of informed consent for use of the CarePorter device, the availability of the bed and CarePorter device, and the type of bed the patient occupied (either specialty bed or standard bed). Though there were no overall statistical differences between the patient in transport group, respiratory illness was more severe in the CP group. This selection bias occurred in four patients because of the severity of their respiratory illness. Both the attending SICU physician and the service attending physician did not believe transport of these patients with manual ventilation was safe, and would only allow the patient to be transported on a ventilator that was capable of providing the appropriate settings for the patient. Since these four patients were more ill than the standard transport patients, this bias could be expected to increase the work involved in the CarePorter group. However, this did not translate into additional time for nurses, respiratory therapists, or escort personnel. Therefore the continued development of devices such as the CarePorter which facilitate a difficult task such as the CarePorter which facilitate a difficult task such as intrahospital transport, and do so while reducing nursing, ancillary and respiratory therapist time, is a welcome cost saving addition to intensive care."}

{"project":"Colil","denotations":[{"id":"T7","span":{"begin":4723,"end":4724},"obj":"7622953"},{"id":"T8","span":{"begin":5109,"end":5110},"obj":"1433406"},{"id":"T9","span":{"begin":4895,"end":4896},"obj":"1433406"},{"id":"T10","span":{"begin":8131,"end":8133},"obj":"3135417"},{"id":"T11","span":{"begin":8127,"end":8128},"obj":"7587230"},{"id":"T12","span":{"begin":8129,"end":8130},"obj":"2302952"},{"id":"T13","span":{"begin":1052,"end":1053},"obj":"2245620"},{"id":"T14","span":{"begin":161,"end":162},"obj":"7622953"},{"id":"T15","span":{"begin":8125,"end":8126},"obj":"7622953"}],"namespaces":[{"prefix":"_base","uri":"http://pubannotation.org/docs/sourcedb/PubMed/sourceid/"}],"text":"Discussion\nIntrahospital transport involves significant utilization of resources, personnel time and interruption of care delivered to a critically ill patient [5]. This study examined the utilization of these resources and the amount of time required to safely transport a patient to an in-hospital diagnostic test or procedure. The traditional means of transport was compared with a new self-contained device, the CarePorter, with in-room and transport capabilities. The use of the CarePorter device required less resource personnel to safely transport the patient to a diagnostic test or procedure when compared with current intrahospital transport. This decrease in personnel did not result in a decrement in care, or an increase in patient or staff injury in the CarePorter group. This decrease in utilization of resources is of paramount importance in an era of medicine where increased pressures to reduce cost are ever present.\nIn response to complications that occur during intrahospital transport, Link et al designed a mobile transfer unit [2]. This could be attached to the patient's bed to provide power and gas for continuous treatment and monitoring of patients during transport. The system was designed in an effort to decrease changes in patients' level of care during transport and prevent complications. Since the introduction of the transfer unit for the study they experienced no unanticipated problems during intrahospital transport. This study supports the concept of the CarePorter device in providing streamlined patient care during transport, but did not address the savings in resource utilization.\nTime, equipment and personnel are needed to transport a patient. The amount of time involved of the bedside nurse to ready a patient for transport includes the coordination of the equipment needed, such as the emergency drug bag, portable electrocardiographic monitor, portable O2 saturation monitor and/or defibrillator, portable suction, and other equipment specific to the patients' needs. This must occur without compromising care to the patients assigned to the nurse. Not only does the equipment need to be readied, but also the patient must be prepared. This preparation includes psychological support to the patient and possible transfer to a stretcher. We found that there was no significant difference between the amount of time taken to ready a patient in each group. However, those patients who were transferred to a stretcher required on average an extra 21 min to ready. This time was direct time away from patient care. If the number of patients in this study were greater, the CarePorter group may in fact have demonstrated a statistical advantage in the time necessary to ready the patient for transport.\nThe location of the test site in relation to the ICU and the availability of the elevator determine transit time to a test site. Despite the perception that transit time is lengthy, it was surprisingly short, and did not depend on the mode of transport. Thus, the CarePorter device did not take longer to maneuver in and out of difficult areas such as elevators, which is a current criticism of the specialty bed and the reason that the patient is moved to a stretcher for transport.\nOnce the patient has returned to the SICU, he/she must be returned to pretransport status. This includes, but it not limited to, re-attaching the patient to the in-room monitoring system, arranging the iv pumps and poles straightening iv lines, straightening and or changing sheets, and the placement of drains to suction. All transported patients underwent this procedure; however, the amount of time required to return the patient to his/her baseline status was significantly different among groups. The average recovery time for the SB group was 22 min because time and personnel were required to transfer a patient back to the specialty bed from the stretcher. This action alone poses many risks to the patient, including extubation, discontinuation of lines and general discomfort, not to mention the possibility of back strain to the staff. The S group required 17.8 min to return the patient to his/her baseline status whereas the CP group required only 10.7 min. Because the pumps and ventilator were attached to the patient's bed, a simple disconnection of the device from the bed occurred. Thus, between 7-12 min per transport was saved during the return to baseline. This saving in time also improves the quality of care delivered to both the transported patient and those remaining in the ICU.\nDepending on the acuity of the remaining patients in the unit and the responsibilities of those individuals covering patient care, nurses were not always able to complete routine care [5]. The transporting nurse must, therefore, assume this care upon return to the unit. This increase in workload of the remaining staff nurses may lead to increased stress [7]. The issue of care of the remaining ICU patients is critical. Unless a qualified outside team transports the patient to the test, leaving the staff nurse in the unit, the care of the other patients is affected [7]. Though we did not find a difference between the modes of transport with respect to the care of the patients remaining in the unit, any modality that decreases time taken arranging and conducting the transport is beneficial.\nThe nurses' satisfaction with the overall transport was greater with the CP group. Nurses were more satisfied because the device was easy to maneuver, all additional equipment was attached, there were no iv pole(s) to push and there was no need for manual ventilation. Coupling and uncoupling the device prior to and upon return to the SICU was easy and required minimal time. The patient was returned to baseline status more quickly and overall the CarePorter made the transport easier. Since intrahospital transport is a source of angst among staff, anything that can reasonably improve this process is warranted.\nSince all patients were mechanically ventilated in this study the respiratory therapist was not included in calculating the number of transporting personnel. However, significant reductions in overall respiratory time were seen with the use of the CarePorter device. On average, 20 min of respiratory time per transport could be saved with the use of the CarePorter device. Since in a unit the number of intrahospital transports ranges from one to 10 per week (average of three), this could result in significant savings of respiratory therapy personnel time. However, unless the nurse assumes responsibility for connecting the air/oxygen tanks to the wall supply, the respiratory therapist would still need to accompany the patient to and from the test site. This task is simple, but would require additional education.\nIn addition to reducing respiratory therapy personnel time, the CarePorter provided a saving of one person per transport, with the overall time for transport of about 40 min for the standard bed, with an additional 40 min for transport of the specialty bed/stretcher group. Thus, savings of escort personnel would occur when a large number of transports are needed. The financial impact of this transporter depends on the standards for transport at a particular institution, and the number of transports of mechanically ventilated patients. The reductions in nursing time are more difficult to report in terms of actual cost savings for the unit because the workload of the transporting nurse is shifted to nurses remaining in the ICU. Improved efficiency is the expected outcome rather than reduced cost, with care that would not be provided because the transporting nurse was not present for a certain period being minimized as time away from the unit decreases.\nThe issue of patient and staff safety is important throughout the hospitalization, irrespective of the patient's location. Although every effort is made to prevent such incidents, inadvertent discontinuation of iv catheters, drains and iv fluid does occur during transport. Reports of these occurrences vary depending on data collection definitions for transport related complications [5,8,9,10]. There is also potential for minor staff injuries to occur during pushing the patient and equipment to the test site. In this study minor injuries occurred irrespective of the patient group. The advantage of the CarePorter should be that as all equipment is attached to the patient's bed and moves as one unit, the risk of injury is reduced; however, this may be offset by the fact that the CarePorter is a heavier device.\nThis study was a prospective trial of transports that occurred over a 3-month period. Randomization of patients was affected by a variety of factors including the presence of informed consent for use of the CarePorter device, the availability of the bed and CarePorter device, and the type of bed the patient occupied (either specialty bed or standard bed). Though there were no overall statistical differences between the patient in transport group, respiratory illness was more severe in the CP group. This selection bias occurred in four patients because of the severity of their respiratory illness. Both the attending SICU physician and the service attending physician did not believe transport of these patients with manual ventilation was safe, and would only allow the patient to be transported on a ventilator that was capable of providing the appropriate settings for the patient. Since these four patients were more ill than the standard transport patients, this bias could be expected to increase the work involved in the CarePorter group. However, this did not translate into additional time for nurses, respiratory therapists, or escort personnel. Therefore the continued development of devices such as the CarePorter which facilitate a difficult task such as the CarePorter which facilitate a difficult task such as intrahospital transport, and do so while reducing nursing, ancillary and respiratory therapist time, is a welcome cost saving addition to intensive care."}