Systematic risk management for aplanned gas shutdown in the high-care facility of auniversity hospital

Abstract

In the course of building extension works at Dresden University Hospital, it was necessary to shut down the central medical gas supply in abuilding with 3 intensive care wards with 22beds, an operating theater tract with 5 operating rooms and 6 normal wards each with 28beds during ongoing services. Thus, for the construction phase there was aneed to establish an interim decentralized gas supply with zero failure tolerance for the affected functional units . Following established procedures for possible risk and failure analysis, aproject group was set up by the hospital's emergency and disaster management officer to develop aproject plan, aneeds assessment and acommunication plan. Avariety of risk factors were systematically identified for which appropriate countermeasures needed to be designed. The needs assessment over 4 h based on physiological parameters for the maximum available 22ventilator beds resulted in 26,000 l of oxygen and 26,000 l of compressed air. A total of 7 supply points were each equipped with two 50l cylinders for both oxygen and compressed air, with atotal availability of 175,000 l of each of the 2 gases. Another eight cylinders each were held in reserve. The project was carried out on aSaturday without an elective surgery program, so that the operating rooms concerned could be closed. The timing was chosen so that double staffing of intensive care personnel was available during the afternoon shift change. In advance, as many of the patients on mechanical ventilation as possible were transferred within the hospital; however, nine of the mechanically ventilated patients had to remain. The technical intervention in the gas supply lasted only 2 h without affecting the patient's condition. During the 2‑h interim supply, 16,500 l of compressed air and 8000 l of oxygen were consumed on the high-care wards. The calculated hourly consumption per ventilated patient was 917 l of air (15 l/min) and 444 l of oxygen (7 l/min). The quantity framework based on empirical values from intensive care medicine was significantly lower. This was more than compensated for by the 10-fold stocking of gas and the predictably lower number of ventilated patients than the maximum occupancy used as abasis. For technical interventions in high-risk areas, careful planning and execution in an effective team is required. Established procedures of project management and risk assessment help to avoid errors.