Introduction
Globally healthcare systems and healthcare professionals (HCP) are under increasing pressure, in particular due to the growing shortage of healthcare workers1. Reducing the intra-hospital patient transportation could potentially free up HCP resources. Intra-hospital transport can further be associated to patient risks due to unexpected events during the transfer2 specifically, transportation of clinical ill patients which have been significantly correlated with adverse events3. Additionally, nurses perceive intra-hospital transport as a cause of stress and increased workload.4 When transferring critical patients there are several parameters to consider, the electromedical equipment, stability condition and the short time to extract information of the patient to continue with a safe and suitable transfer 5. The current study investigates the potential benefits of having single-use therapeutical gastroscopes, needed equipment and utilities available in the intensive care unit (ICU), to treat ICU admitted patients presenting an upper gastrointestinal bleed (UGIB).
Aims & Methods
Between January 2021 and October 2022, an anonymous survey was distributed across 8 countries (Australia, France, Germany, Italy, Spain, United Kingdom, United States of America and Japan). The survey was distributed through M3 Global Research. The main target of the survey were gastroenterologists and gastrointestinal surgeons, from public hospitals, public university hospitals, private hospitals, private clinics, screening centers and ambulatory surgery centers (ASC). Data was collected through Survey Exact and analyzed in Excel.
Results
341 answers from gastrointestinal surgeons and gastroenterologists were collected. 3% of ICU patients present an UGIB during admission. Presently, 45% of patients with UGIB are treated in the ICU, 24% of patients are currently transported to the operating room (OR) and 31% to the endoscopy unit (EU). The average time used transporting patients from the ICU is 21min and 22min to the OR and EU, respectively. 5 to 6 HCP are needed to transport an UGIB patient from ICU to OR/EU. Physicians assumed that 46% CI [42.1;49.9%] of currently transported ICU patients could avoid being transported if single-use therapeutical gastroscopes were available in the ICU and the UGIB management was equally efficient in the ICU as in the OR or EU, meaning 75% of UGIB patients could be managed in the ICU compared to current handling.
Conclusion
The risk and resources associated to intra hospital transport of critical ill patients with UGIB could be reduced in 46% if therapeutical gastroscopes, needed equipment and utilities are available in the ICU. Thereafter, the portability and availability of the single-use therapeutical gastroscope in this scenario, could allow faster attention to the patient in need, free up time, workload and stress of HCP and other staff which are currently involved in the transport and handling of patients with UGIB from ICU.
References
1. Rivlin A, Lumley T. Why is the world now facing a medical recruitment crisis? | World Economic Forum. 2023. Published 2016. Accessed April 27, 2023. https://www.weforum.org/agenda/2023/01/medical-recruitment-crisis-davos23/.
2. Papson JPN, Russell KL, Taylor DMD. Unexpected Events during the Intrahospital Transport of Critically Ill Patients. Acad Emerg Med. 2007;14(6):574-577. doi:10.1197/j.aem.2007.02.034
3. Parmentier-Decrucq E, Poissy J, Favory R, et al. Adverse events during intrahospital transport of critically ill patients: Incidence and risk factors. Ann Intensive Care. 2013;3(1):1-10. doi:10.1186/2110-5820-3-10
4. Song Y, Zhao Q, Yang M, Xie X, Gong M, Chen H. Intrahospital transport of critically ill patients: A cross-sectional survey of Nurses’ attitudes and experiences in adult intensive care units. J Adv Nurs. 2022;78(9):2775-2784. doi:10.1111/JAN.15179
5. Jiménez Herrera MF, Valero Mora E. El traslado interhospitalario de un paciente con hemorragia digestiva por varices esofágicas. Enfermería Clínica. 2011;21(5):284-287. doi:10.1016/J.ENFCLI.2010.12.004
Disclosure
Study started by Ambu. Authors currently working for Ambu.