A Case of Iatrogenic Vascular Air Embolism Treated with Bipap and Nitroglycerin

Abstract

Background: There is little scientific data to guide inter-hospital transport of critically ill patients. This leads to practice variation with how providers communicate healthcare information between facilities and inappropriate communication can lead to significant patient harm. We analyzed data used by accepting providers during hospital transfer to form a rational protocol for information exchange. Methods: We conducted a prospective observational study of inter-hospital patient transfers to our medical intensive care unit (ICU). We recorded data that receiving clinicians requested, and whether that information was available upon admission. Following observation, we asked providers to complete a survey indicating whether a data point was useful for clinical decision making for the particular clinical case they had received. We analyzed the relative frequency of data requests and the discordance between available and requested data. Results: Twenty-five physician-patient interactions were observed with 45 surveys completed by critical care providers. On average, 13 data points were utilized for patients with perceived “mild” illness versus 18 data points for patients with “severe” illness. The most requested data were code status (19/25), blood culture status (19/25), and medications administered to the patient (16/25). Other data points identified as useful were past medical history, vital signs, white blood cell count, hemoglobin, lactate, pH, PaCO2 and chest x-ray findings with minimal variability depending on presumed diagnosis (respiratory failure, sepsis or other). Code status (7/19), arterial/venous blood gas (5/12), lactate (4/10), and medical power of attorney (3/5) were the most frequently unavailable data points when requested. Conclusion: Critical care providers use a small number of data points during the inter-hospital admission process, but many of these are frequently unavailable. A formal structured hand off tool is needed to improve information management during inter-hospital transfer. Such a tool must emphasize resuscitation status, critical labs, and ongoing interventions.