2003 OPEN FORUM Abstracts
RESOURCE UTILIZATION DURING THE TRANSPORT OFADULTS UNDERGOING MECHANICAL VENTIALTION IN A LARGE, URBAN, TERTIARY CARE FACILITY
Russell T. Reid, BBA, RCP, RRT, CPFT, Carolinas Medical Center, Charlotte, NC
Background: The transport of critically ill patients, requiring mechanical ventilation, can be a resource intensive process that presents staffing challenges to the Respiratory Care Department. Patients may be transported to a variety of locations within the hospital and typically the Respiratory Care Practitioner (RCP) must leave at least one Intensive Care Unit (ICU) uncovered for the duration of the transport. Additionally, the RCP may be required to stay with the patient for the duration of the transport.
Method: During a six month period (January - June) data was collected at Carolinas Medical Center, an 843 bed tertiary care center, located in Charlotte, North Carolina, to determine the resources involved in the transport of mechanically ventilated patients within the institution. Data was collected on the duration of the transport, transport team composition, time the transport occurred, transport origination point and transport destination. Transport time was defined as the actual time the RCP was either transporting the patient or was required to remain during a procedure. Preparation time for the transport wasn't included.
RESULTS: There were a total of 1,829 transports, an average of 305 (± 35.9) per month, during the six-month data collection period. The average transport lasted 25.3 (± 3.7) minutes, required 2.8 (± 0.2) team members and was performed during the day shift (0700-1900) 67.0% of the time. There were 4,800 ventilator/days during the data collection period, which translated into one transport for every 2.6 ventilator/days. The largest number of transports originated from the Trauma Intensive Care Unit (TICU), 27.0%, with the Medical Intensive Care Unit (MICU) contributing the second largest number of transports with 20.5%. The two destinations accounting for the largest number of transports were the Radiology Department and intra-hospital ICU transfers, accounting for 35.0% and 21.0% of total transports, respectively. Analysis of the data revealed the resource consumption patterns shown in Table 1.
|n||Team Composition per Transport RCP/RN/ Other||Number of RCP Hrs/FTE Required per Month For Transport||% of Time RCP/RN Had to Remain with Pt. During Procedure||Number of RN Hrs/FTE per Month For Transport|
|Transport Summary||1829||1.1 (± 0.0) 1.5 (± 0.1) 0.2 (± 0.0)||140.0 (± 24.1) /.97(± 0.2)*||67%/100%||186.7 (± 35.8) /1.29 (± 0.2)*|
Table 1. Transport Statistics for the six-month data collection period.
* - 144 working hours per month = 1 FTE
Experience: The author has been personally involved in a large number transports involving mechanically ventilated adult patients during his career as a Respiratory Care Practitioner.
Conclusions: The transport of critically ill patients undergoing mechanical ventilation required approximately 1 FTE (0.97 FTE) per month from the Respiratory Care Department to perform the transport. Conversely, this also meant that overall ICU coverage was reduced by approximately 1 FTE per month. Based upon the results of this data alternative forms of transport coverage, such as a dedicated transport team, may be warranted in large, tertiary care centers which perform large numbers of transports involving mechanically ventilated patients.