A look at the past to draw lessons for the future: how the case of an urgent ICU transfer taught us to always be ready with a plan B
ObjectiveThe urgent transfer of an intensive care unit (ICU) is particularly challenging because it carries a high clinical and infectious risk and is a critical node in a hospital’s patient flow. In early 2017, exceptional rainfall damaged the roof of the tertiary hospital in Udine, necessitating t...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-11-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2023.1253673/full |
| _version_ | 1827714194147901440 |
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| author | Laura Brunelli Laura Brunelli Edoardo Miotto Massimo Del Pin Daniele Celotto Adriana Moccia Gianni Borghi Amato De Monte Cristiana Macor Roberto Cocconi Luca Lattuada Silvio Brusaferro Luca Arnoldo Luca Arnoldo |
| author_facet | Laura Brunelli Laura Brunelli Edoardo Miotto Massimo Del Pin Daniele Celotto Adriana Moccia Gianni Borghi Amato De Monte Cristiana Macor Roberto Cocconi Luca Lattuada Silvio Brusaferro Luca Arnoldo Luca Arnoldo |
| author_sort | Laura Brunelli |
| collection | DOAJ |
| description | ObjectiveThe urgent transfer of an intensive care unit (ICU) is particularly challenging because it carries a high clinical and infectious risk and is a critical node in a hospital’s patient flow. In early 2017, exceptional rainfall damaged the roof of the tertiary hospital in Udine, necessitating the relocation of one of the three ICUs for six months. We decided to assess the impact of this transfer on quality of care and patient safety using a set of indicators, primarily considering the incidence of healthcare-associated infections (HAIs) and mortality rates.MethodsWe performed a retrospective, observational analysis of structural, process, and outcome indicators comparing the pre- and posttransfer phases. Specifically, we analyzed data between July 2016 and June 2017 for the transferred ICU and examined mortality and the incidence of HAI.ResultsDespite significant changes in structural and organizational aspects of the unit, no differences in mortality rates or cumulative incidence of HAIs were observed before/after transfer. We collected data for all 393 patients (133 women, 260 men) admitted to the ICU before (49.4%) and after transfer (50.6%). The mortality rate for 100 days in the ICU was 1.90 (34/1791) before and 2.88 (37/1258) after transfer (p = 0.063). The evaluation of the occurrence of at least one HAI included 304 patients (102 women and 202 men), as 89 of them were excluded due to a length of stay in the ICU of less than 48 h; again, there was no statistical difference between the two cumulative incidences (13.1% vs. 6.9%, p = 0.075).ConclusionIn the case studied, no adverse effects on patient outcomes were observed after urgent transfer of the injured ICU. The indicators used in this study may be an initial suggestion for further discussion. |
| first_indexed | 2024-03-10T18:52:21Z |
| format | Article |
| id | doaj.art-67aeb3af75ca40dfbb60bb2a0b0de3bc |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-03-10T18:52:21Z |
| publishDate | 2023-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-67aeb3af75ca40dfbb60bb2a0b0de3bc2023-11-20T05:04:43ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2023-11-011010.3389/fmed.2023.12536731253673A look at the past to draw lessons for the future: how the case of an urgent ICU transfer taught us to always be ready with a plan BLaura Brunelli0Laura Brunelli1Edoardo Miotto2Massimo Del Pin3Daniele Celotto4Adriana Moccia5Gianni Borghi6Amato De Monte7Cristiana Macor8Roberto Cocconi9Luca Lattuada10Silvio Brusaferro11Luca Arnoldo12Luca Arnoldo13Dipartimento di Area Medica, Università degli Studi di Udine, Udine, ItalySOC Rischio Clinico, Qualità e Accreditamento, Azienda Sanitaria Universitaria Friuli Centrale, Udine, ItalyDipartimento di Area Medica, Università degli Studi di Udine, Udine, ItalyDipartimento di Area Medica, Università degli Studi di Udine, Udine, ItalyDipartimento di Area Medica, Università degli Studi di Udine, Udine, ItalyDirezione Medica, Presidio Ospedaliero Universitario S. Maria della Misericordia di Udine, Azienda Sanitaria Universitaria Friuli Centrale, Udine, ItalyDirezione Medica, Presidio Ospedaliero Universitario S. Maria della Misericordia di Udine, Azienda Sanitaria Universitaria Friuli Centrale, Udine, ItalyDipartimento di Anestesia e Rianimazione, Azienda Sanitaria Universitaria Friuli Centrale, Udine, ItalyDipartimento di Anestesia e Rianimazione, Azienda Sanitaria Universitaria Friuli Centrale, Udine, ItalySOC Rischio Clinico, Qualità e Accreditamento, Azienda Sanitaria Universitaria Friuli Centrale, Udine, ItalyDirezione Medica, Presidio Ospedaliero Universitario S. Maria della Misericordia di Udine, Azienda Sanitaria Universitaria Friuli Centrale, Udine, ItalyDipartimento di Area Medica, Università degli Studi di Udine, Udine, ItalyDipartimento di Area Medica, Università degli Studi di Udine, Udine, ItalySOC Rischio Clinico, Qualità e Accreditamento, Azienda Sanitaria Universitaria Friuli Centrale, Udine, ItalyObjectiveThe urgent transfer of an intensive care unit (ICU) is particularly challenging because it carries a high clinical and infectious risk and is a critical node in a hospital’s patient flow. In early 2017, exceptional rainfall damaged the roof of the tertiary hospital in Udine, necessitating the relocation of one of the three ICUs for six months. We decided to assess the impact of this transfer on quality of care and patient safety using a set of indicators, primarily considering the incidence of healthcare-associated infections (HAIs) and mortality rates.MethodsWe performed a retrospective, observational analysis of structural, process, and outcome indicators comparing the pre- and posttransfer phases. Specifically, we analyzed data between July 2016 and June 2017 for the transferred ICU and examined mortality and the incidence of HAI.ResultsDespite significant changes in structural and organizational aspects of the unit, no differences in mortality rates or cumulative incidence of HAIs were observed before/after transfer. We collected data for all 393 patients (133 women, 260 men) admitted to the ICU before (49.4%) and after transfer (50.6%). The mortality rate for 100 days in the ICU was 1.90 (34/1791) before and 2.88 (37/1258) after transfer (p = 0.063). The evaluation of the occurrence of at least one HAI included 304 patients (102 women and 202 men), as 89 of them were excluded due to a length of stay in the ICU of less than 48 h; again, there was no statistical difference between the two cumulative incidences (13.1% vs. 6.9%, p = 0.075).ConclusionIn the case studied, no adverse effects on patient outcomes were observed after urgent transfer of the injured ICU. The indicators used in this study may be an initial suggestion for further discussion.https://www.frontiersin.org/articles/10.3389/fmed.2023.1253673/fullICU transferrisk managementhealthcare-associated infectionsemergencypreparedness |
| spellingShingle | Laura Brunelli Laura Brunelli Edoardo Miotto Massimo Del Pin Daniele Celotto Adriana Moccia Gianni Borghi Amato De Monte Cristiana Macor Roberto Cocconi Luca Lattuada Silvio Brusaferro Luca Arnoldo Luca Arnoldo A look at the past to draw lessons for the future: how the case of an urgent ICU transfer taught us to always be ready with a plan B Frontiers in Medicine ICU transfer risk management healthcare-associated infections emergency preparedness |
| title | A look at the past to draw lessons for the future: how the case of an urgent ICU transfer taught us to always be ready with a plan B |
| title_full | A look at the past to draw lessons for the future: how the case of an urgent ICU transfer taught us to always be ready with a plan B |
| title_fullStr | A look at the past to draw lessons for the future: how the case of an urgent ICU transfer taught us to always be ready with a plan B |
| title_full_unstemmed | A look at the past to draw lessons for the future: how the case of an urgent ICU transfer taught us to always be ready with a plan B |
| title_short | A look at the past to draw lessons for the future: how the case of an urgent ICU transfer taught us to always be ready with a plan B |
| title_sort | look at the past to draw lessons for the future how the case of an urgent icu transfer taught us to always be ready with a plan b |
| topic | ICU transfer risk management healthcare-associated infections emergency preparedness |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2023.1253673/full |
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