Component analyses for effectiveness of compressions and ventilations in bystander cardiopulmonary resuscitation

Abstract

Reducing time from acceptance to intensive care unit arrival Donna K. Berner, John A. Terrell, Sharill L. Bernhard, Lorraine S. Layton, Joseph L. Nates The University of Texas MD Anderson Cancer Center, Houston, TX, USA Background/Purpose: The lack of bed availability leads to patient care delays and increases complications and patient dissatisfaction. As part of our institutional continuous performance improvement goals, we aimed to improve our intensive care unit (ICU) admission process by gaining a better understanding of the process through the use of industrial engineering tools. Methods: We investigated all nonoperative admissions to the ICU from May 21, 2014, to December 31, 2014 (n = 929). Using standard industrial engineering techniques, process flow maps, Ishikawa diagrams, and plan-do-study-act (PDSA) cycles, key quality indicators affecting the admission process were prospectively collected and validated against the ICU database. The study database consisted of time of referral, acceptance, ICU arrival time, referral service, and location and reason for delay in transport. Results: Patients pulled to ICUby the code teamor the rapid response team (RRT) arrived statistically significantly faster than patients pushed to ICU from the referral location (27 vs 71minutes, P b .001). Patientwith delayed transport took 4 times as long to arrive as code and RRT patients and twice as long to arrive as nondelayed patients (105 vs 60 vs 26 minutes 1-way ANOVA, P b .0001). Conclusions: The use of the pulling technique was significantly more effective than the pushing technique in the ICU admission process. In busy units, a dedicated ICU driven transport team could lead to more efficient and time-sensitive ICU critically ill patient admission. This team would work in parallel to the rapid response or code team for a more efficient ICU admission process.