Improving Efficiency and Patient Safety at The Point of Admission;The Introduction of Portable Procedural Equipement Stations

ABSTRACT

Introduction: Admitting acutely unwell patients to the intensive care unit (ICU) can represent a busy and challenging time, particularly out of hours or in the context of surge into areas not usually utilised for delivery of intensive care. It is usual for the team to perform a number of procedures at the point of admission in order to stabilise the patient. Objectives: During the Covid-19 surge it was noted that efficiency and potentially patient safety were being compromised by the time taken to locate essential equipment required to carry out the frequent and specialist procedures that are often performed at admission. This quality improvement project set out to address this short fall by introducing mobile workstations that were fully stocked with the required equipment and provided a working surface. Four different stations were introduced a general station (Intravenous, central, and arterial access, blood cultures, nasogastric tube insertion, urinary catheter insertion) and 3 specialist procedure stations an intercostal chest drain station, airway station and a percutaneous tracheostomy/lumbar puncture station. A spare general station was kept stocked in a storeroom so that after use stations could be replaced immediately. Laminated contents lists with photographs of drawer layouts were attached to allow restocking. General stations were sealed before being positioned in designated positions, marked on the floor, in each of the different clinical areas. The stations were designed to be easily cleaned to conform to infection control protocols. Methods: Medical staff performed an electronic questionnaire before and after the introduction of the equipment stations. Results: The 12 responders reported performing, on average 4 procedure per admission. Pre-intervention the average reported time taken to find equipment need was reported to be 22.5 minutes, with a further average 18.5 minutes taken by a second member of staff, usually bedside nursing staff. Post intervention these reported times fell to 7.5 minutes and 7 minute respectively, at time saving of 40.7 minutes (65%). In 2018/2019 our unit admitted 788 patients, therefore over a year we could potential save up to 535 hours, with the financial implications being obvious. The post intervention questionnaire contained a significant number of positive comments regarding the stations from staff. Conclusion: This simple intervention is clearly able to improve patient safety, reduce frustration amongst staff as well as save time and money. The mobile nature of the stations allowed them to be used in other areas when required such as theatre, recovery and the emergency department, a feature which has been particularly beneficial during the Covid-19 surge. Other units may want to consider this set up as a way of improving safety and efficiency.