Cargando…

Benchmarking Hospital Practices and Policies on Intrahospital Neurocritical Care Transport: The Safe-Neuro-Transport Study

An electronic survey was administered to multidisciplinary neurocritical care providers at 365 hospitals in 32 countries to describe intrahospital transport (IHT) practices of neurocritically ill patients at their institutions. The reported IHT practices were stratified by World Bank country income...

Descripción completa

Detalles Bibliográficos
Autores principales: Zirpe, Kapil G., Alunpipatthanachai, Bhunyawee, Matin, Nassim, Gulek, Bernice G., Blissitt, Patricia A., Palmieri, Katherine, Rosenblatt, Kathryn, Athiraman, Umeshkumar, Gollapudy, Suneeta, Theard, Marie Angele, Wahlster, Sarah, Vavilala, Monica S., Lele, Abhijit V.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10179223/
https://www.ncbi.nlm.nih.gov/pubmed/37176625
http://dx.doi.org/10.3390/jcm12093183
_version_ 1785041046928883712
author Zirpe, Kapil G.
Alunpipatthanachai, Bhunyawee
Matin, Nassim
Gulek, Bernice G.
Blissitt, Patricia A.
Palmieri, Katherine
Rosenblatt, Kathryn
Athiraman, Umeshkumar
Gollapudy, Suneeta
Theard, Marie Angele
Wahlster, Sarah
Vavilala, Monica S.
Lele, Abhijit V.
author_facet Zirpe, Kapil G.
Alunpipatthanachai, Bhunyawee
Matin, Nassim
Gulek, Bernice G.
Blissitt, Patricia A.
Palmieri, Katherine
Rosenblatt, Kathryn
Athiraman, Umeshkumar
Gollapudy, Suneeta
Theard, Marie Angele
Wahlster, Sarah
Vavilala, Monica S.
Lele, Abhijit V.
author_sort Zirpe, Kapil G.
collection PubMed
description An electronic survey was administered to multidisciplinary neurocritical care providers at 365 hospitals in 32 countries to describe intrahospital transport (IHT) practices of neurocritically ill patients at their institutions. The reported IHT practices were stratified by World Bank country income level. Variability between high-income (HIC) and low/middle-income (LMIC) groups, as well as variability between hospitals within countries, were expressed as counts/percentages and intracluster correlation coefficients (ICCs) with a 95% confidence interval (CI). A total of 246 hospitals (67% response rate; n = 103, 42% HIC and n = 143, 58% LMIC) participated. LMIC hospitals were less likely to report a portable CT scanner (RR 0.39, 95% CI [0.23; 0.67]), more likely to report a pre-IHT checklist (RR 2.18, 95% CI [1.53; 3.11]), and more likely to report that intensive care unit (ICU) physicians routinely participated in IHTs (RR 1.33, 95% CI [1.02; 1.72]). Between- and across-country variation were highest for pre-IHT external ventricular drain clamp tolerance (reported by 40% of the hospitals, ICC 0.22, 95% CI 0.00–0.46) and end-tidal carbon dioxide monitoring during IHT (reported by 29% of the hospitals, ICC 0.46, 95% CI 0.07–0.71). Brain tissue oxygenation monitoring during IHT was reported by only 9% of the participating hospitals. An IHT standard operating procedure (SOP)/hospital policy (HP) was reported by 37% (n = 90); HIC: 43% (n= 44) vs. LMIC: 32% (n = 46), p = 0.56. Amongst the IHT SOP/HPs reviewed (n = 13), 90% did not address the continuation of hemodynamic and neurophysiological monitoring during IHT. In conclusion, the development of a neurocritical-care-specific IHT SOP/HP as well as the alignment of practices related to the IHT of neurocritically ill patients are urgent unmet needs. Inconsistent standards related to neurophysiological monitoring during IHT warrant in-depth scrutiny across hospitals and suggest a need for international guidelines for neurocritical care IHT.
format Online
Article
Text
id pubmed-10179223
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-101792232023-05-13 Benchmarking Hospital Practices and Policies on Intrahospital Neurocritical Care Transport: The Safe-Neuro-Transport Study Zirpe, Kapil G. Alunpipatthanachai, Bhunyawee Matin, Nassim Gulek, Bernice G. Blissitt, Patricia A. Palmieri, Katherine Rosenblatt, Kathryn Athiraman, Umeshkumar Gollapudy, Suneeta Theard, Marie Angele Wahlster, Sarah Vavilala, Monica S. Lele, Abhijit V. J Clin Med Article An electronic survey was administered to multidisciplinary neurocritical care providers at 365 hospitals in 32 countries to describe intrahospital transport (IHT) practices of neurocritically ill patients at their institutions. The reported IHT practices were stratified by World Bank country income level. Variability between high-income (HIC) and low/middle-income (LMIC) groups, as well as variability between hospitals within countries, were expressed as counts/percentages and intracluster correlation coefficients (ICCs) with a 95% confidence interval (CI). A total of 246 hospitals (67% response rate; n = 103, 42% HIC and n = 143, 58% LMIC) participated. LMIC hospitals were less likely to report a portable CT scanner (RR 0.39, 95% CI [0.23; 0.67]), more likely to report a pre-IHT checklist (RR 2.18, 95% CI [1.53; 3.11]), and more likely to report that intensive care unit (ICU) physicians routinely participated in IHTs (RR 1.33, 95% CI [1.02; 1.72]). Between- and across-country variation were highest for pre-IHT external ventricular drain clamp tolerance (reported by 40% of the hospitals, ICC 0.22, 95% CI 0.00–0.46) and end-tidal carbon dioxide monitoring during IHT (reported by 29% of the hospitals, ICC 0.46, 95% CI 0.07–0.71). Brain tissue oxygenation monitoring during IHT was reported by only 9% of the participating hospitals. An IHT standard operating procedure (SOP)/hospital policy (HP) was reported by 37% (n = 90); HIC: 43% (n= 44) vs. LMIC: 32% (n = 46), p = 0.56. Amongst the IHT SOP/HPs reviewed (n = 13), 90% did not address the continuation of hemodynamic and neurophysiological monitoring during IHT. In conclusion, the development of a neurocritical-care-specific IHT SOP/HP as well as the alignment of practices related to the IHT of neurocritically ill patients are urgent unmet needs. Inconsistent standards related to neurophysiological monitoring during IHT warrant in-depth scrutiny across hospitals and suggest a need for international guidelines for neurocritical care IHT. MDPI 2023-04-28 /pmc/articles/PMC10179223/ /pubmed/37176625 http://dx.doi.org/10.3390/jcm12093183 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Zirpe, Kapil G.
Alunpipatthanachai, Bhunyawee
Matin, Nassim
Gulek, Bernice G.
Blissitt, Patricia A.
Palmieri, Katherine
Rosenblatt, Kathryn
Athiraman, Umeshkumar
Gollapudy, Suneeta
Theard, Marie Angele
Wahlster, Sarah
Vavilala, Monica S.
Lele, Abhijit V.
Benchmarking Hospital Practices and Policies on Intrahospital Neurocritical Care Transport: The Safe-Neuro-Transport Study
title Benchmarking Hospital Practices and Policies on Intrahospital Neurocritical Care Transport: The Safe-Neuro-Transport Study
title_full Benchmarking Hospital Practices and Policies on Intrahospital Neurocritical Care Transport: The Safe-Neuro-Transport Study
title_fullStr Benchmarking Hospital Practices and Policies on Intrahospital Neurocritical Care Transport: The Safe-Neuro-Transport Study
title_full_unstemmed Benchmarking Hospital Practices and Policies on Intrahospital Neurocritical Care Transport: The Safe-Neuro-Transport Study
title_short Benchmarking Hospital Practices and Policies on Intrahospital Neurocritical Care Transport: The Safe-Neuro-Transport Study
title_sort benchmarking hospital practices and policies on intrahospital neurocritical care transport: the safe-neuro-transport study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10179223/
https://www.ncbi.nlm.nih.gov/pubmed/37176625
http://dx.doi.org/10.3390/jcm12093183
work_keys_str_mv AT zirpekapilg benchmarkinghospitalpracticesandpoliciesonintrahospitalneurocriticalcaretransportthesafeneurotransportstudy
AT alunpipatthanachaibhunyawee benchmarkinghospitalpracticesandpoliciesonintrahospitalneurocriticalcaretransportthesafeneurotransportstudy
AT matinnassim benchmarkinghospitalpracticesandpoliciesonintrahospitalneurocriticalcaretransportthesafeneurotransportstudy
AT gulekberniceg benchmarkinghospitalpracticesandpoliciesonintrahospitalneurocriticalcaretransportthesafeneurotransportstudy
AT blissittpatriciaa benchmarkinghospitalpracticesandpoliciesonintrahospitalneurocriticalcaretransportthesafeneurotransportstudy
AT palmierikatherine benchmarkinghospitalpracticesandpoliciesonintrahospitalneurocriticalcaretransportthesafeneurotransportstudy
AT rosenblattkathryn benchmarkinghospitalpracticesandpoliciesonintrahospitalneurocriticalcaretransportthesafeneurotransportstudy
AT athiramanumeshkumar benchmarkinghospitalpracticesandpoliciesonintrahospitalneurocriticalcaretransportthesafeneurotransportstudy
AT gollapudysuneeta benchmarkinghospitalpracticesandpoliciesonintrahospitalneurocriticalcaretransportthesafeneurotransportstudy
AT theardmarieangele benchmarkinghospitalpracticesandpoliciesonintrahospitalneurocriticalcaretransportthesafeneurotransportstudy
AT wahlstersarah benchmarkinghospitalpracticesandpoliciesonintrahospitalneurocriticalcaretransportthesafeneurotransportstudy
AT vavilalamonicas benchmarkinghospitalpracticesandpoliciesonintrahospitalneurocriticalcaretransportthesafeneurotransportstudy
AT leleabhijitv benchmarkinghospitalpracticesandpoliciesonintrahospitalneurocriticalcaretransportthesafeneurotransportstudy
AT benchmarkinghospitalpracticesandpoliciesonintrahospitalneurocriticalcaretransportthesafeneurotransportstudy