A handoff protocol from the cardiovascular operating room to cardiac ICU is associated with improvements in care beyond the immediate postoperative period.

BACKGROUND: Handoff protocols from the cardiovascular operating room (CVOR) to the cardiac intensive care unit (CICU) can improve patient outcomes and delivery of care beyond the immediate postoperative period. In a prospective quality improvement study, a structured CVOR-to-CICU handoff protocol was implemented at a university-affiliated children's hospital. As a parallel project, an initiative to reduce unplanned extubations in the CICU was implemented. METHODS: In a 41-month period, 1,507 neonates, infants, children, and adults were admitted to the CICU from the CVOR after undergoing a surgical procedure. The study was divided into a 17-month prehandoff-protocol period (January 2009-May 2010) and a 24-month posthandoff-protocol period (June 2010-May 2012). The handoff protocol was intended to streamline the handoff process from the CVOR and throughout the transition to the CICU. The specifics of the handoff, as outlined in a bedside laminated flowchart, included patient transport from the CVOR, the cardiovascular surgeon's report, the anesthesiologist's report, and the patient status summary and care plan. RESULTS: After introduction of the handoff protocol, there was a statistically significant and sustained reduction in the mean rate of unplanned extubations from 0.62 to 0.24 per 100 ventilator-days (p = .03). There was a statistically significant reduction in median ventilator time per patient--from 17 hours (interquartile range [IQR]: 5.3 to 57.7) to 12.8 hours (IQR: 4.8 to 31.8); p = .02). The mean rate of unplanned extubations was 0.26 in 2011 and 0.30 in 2012. CONCLUSIONS: Implementation of a handoff protocol from the CVOR to the CICU was associated with sustained decrease in unplanned extubations and in mean ventilator times.

A multicenter survey of heparin prophylaxis practice in pediatric critical care.

Heparin prophylaxis (HP) is commonly used for prevention of central venous catheter (CVC)-related complications among pediatric intensivists, yet efficacy of this therapy is unknown. We conducted a survey of pediatric intensivists and their experiences with HP. A total of 96 responses were received. Almost half of the respondents regularly used HP in patients with CVCs, yet most were unsure of its benefit. The majority of respondents claimed to experience no adverse effects; the complications that were reported to occur were related to bleeding or suspected heparin-induced thrombocytopenia (HIT). Overall, participants felt CVC-associated HP was safe in pediatric critical illness, while acknowledging the paucity of compelling data.