RESUMO
BACKGROUND AND OBJECTIVES: The hand-off process between pediatric anesthesia and intensive care unit (ICU) teams involves the exchange of patient health information and plays a major role in reducing errors and increasing staff satisfaction. Our objectives were to (1) standardize the hand-off process in children's ICUs, and (2) evaluate the provider satisfaction, efficiency and sustainability of the improved hand-off process. METHODS: Following multidisciplinary discussions, the hand-off process was standardized for transfers of care between anesthesia-ICU teams. A pre-implementation and two post-implementation (6 months, >2 years) staff satisfaction surveys and audits were conducted to evaluate the success, quality and sustainability of the hand-off process. RESULTS: There was no difference in the time spent during the sign out process following standardization-median 5 min for pre-implementation versus 5 and 6 min for post-implementation at six months and >2 years, respectively. There was a significant decrease in the number of missed items (airway/ventilation, venous access, medications, and laboratory values pertinent events) post-implementation compared to pre-implementation (p ≤ 0.001). In the >2 years follow-up survey, 49.2% of providers felt that the hand-off could be improved versus 78.4% in pre-implementation and 54.2% in the six-month survey (p < 0.001). CONCLUSION: A standardized interactive hand-off improves the efficiency and staff satisfaction, with a decreased rate of missed information at the cost of no additional time.
RESUMO
BACKGROUND: Hyperglycemia during cardiac surgery in nondiabetic patients is a common finding associated with increased morbidity and mortality, but its predictors have not been studied to date. METHODS: To identify clinical and laboratory correlates of excessive and persistent blood glucose (BG) elevation during cardiopulmonary bypass (CPB) in nondiabetic patients, the authors reviewed 195 medical records. After exclusion of patients with preoperative BG >120 mg/dL and with missing preoperative BG data, 163 cases were included in the final analysis. Patients with BG > or =200 mg/dL during CPB and remaining > or =200 mg/dL either during or after CPB or at the first postoperative measurement formed the study group (n = 35). One case had insufficient data to determine group assignment and was not used in comparison. The remaining patients formed the control group (n = 127). RESULTS: BG was > or =200 mg/dL at least once perioperatively in 114 of 163 (70%) patients. It occurred during CPB in 100 of 163 (61%) cases and persisted beyond CPB in 35 of 162 (22%) cases. Univariate analysis revealed a significant difference between groups in preoperative use of angiotensin-converting enzyme (ACE) inhibitors (51% v 29%, p = 0.02), total dose of phenylephrine during CPB (14.1 mg +/- 10.6 mg v 10.3 +/- 9.6 mg, p = 0.003) and pre-CPB BG (123 +/- 22 mg/dL v 113 +/- 18 mg/dL, p = 0.02). In multivariate analysis, ACE inhibitors and pre-CPB BG remained statistically significant. CONCLUSIONS: Nondiabetic patients with excessive and persistent BG elevation during cardiac surgery are more likely to take ACE inhibitors preoperatively, show relatively high pre-CPB BG, and possibly require higher doses of vasoconstrictors during CPB.
