The operating room (OR) is a fast-paced, in-out, on to the next portion of the hospital where timing is critical. Unexpected problems can mean delays in treatment or safety concerns for other critically ill patients. Currently though, there is not a “best practice” for intrahospital transport (IHT) of patients from the OR to the Neurocritical Care Unit (NCU). Often, hospitals use computer simulation or direct observation (time-in-motion) to evaluate practice.
Recently, the healthcare industry has tried to solve so many of these complex processes by using technology. Why rush to it though? Is it really a better way to evaluate care than relying on a nurse who has extensive training in how to observe and document their findings? That’s what our team decided to find out. Especially when, despite IHT from OR to NCU being identified as a high-risk event, we could only find one nursing study exploring this process published in the last five years.
After receiving university Institutional Review Board (IRB) approval, we broke our quality improvement project down into three phases:
- Immersion – Spent time in the OR, accompanying patients from the OR to ICU and in the ICU.
- Model building – Worked with members of the hospital quality improvement team to develop two process maps: one for the transfer of an intubated patient and the other for the transfer of an extubated patient. (We felt that the complexities of the intubated patient, which include airway and ventilation equipment and IV medication equipment, warranted a different look.)
- Model testing – Used time-stamp data and direct observation to record the time at which the patient left the OR and arrived in the ICU.
Ultimately the model testing phase did not work out like we thought it would. Despite a great deal of time and effort placed in developing the process maps, it didn’t prove to be important with data collection at all—it was important to the computer system- but not the people.
Beyond that, the data we obtained from direct observation provided significant support that the current process is actually quite efficient.
We can’t forget that the rush to embrace technology has a cost. Sometimes the cost is monetary, as with the purchase of equipment or software. Sometimes the cost is time associated with learning curves and data capture. Sometimes the loss is the fidelity of observations. Sometimes the loss is nurses themselves—technology often requires the use of computer programmers, who are not usually well-versed in nursing practice.
Nursing is still a person-to-person job that takes special attention to creating changes in the process. Technology isn’t always the answer. In fact, for centuries, the field of nursing was moved forward and scientific discoveries were made based solely on direct observation! At the end of the day, relying on our observations to evaluate the need for change ends up being easier, faster, less expensive, and more accurate.
Denelle Hebert, BSN, RN, is a staff nurse in the Neuroscience Intensive Care Unit at UT Southwestern Medical Center in Dallas, Texas, USA.
DaiWai M. Olson, PhD, RN, CCRN, FNCS, is a Professor at UT Southwestern Medical Center in Dallas, Texas, USA. He is a member of Sigma’s Alpha Alpha Chapter and Beta Beta Chapter.
Co-investigators at UT Southwestern Medical Center are:
- Barsha Thakur, MPH
- Aardhra Venkatachalam
- Sonja Stutzman, PhD