Procedures at Bedside for Intensive Care Unit Patients - Initiating a program May, 2004 - April 2005

Peter A Igneri, Frederick B Rogers, Bruce Crookes, William Charash, Susannah K Wells, Bruce Leavitt
Flethcer Allen Health Care, Burlington, VT

Objective: To decrease complications, resources and costs by moving tracheotomies, gastrostomies and vena cava filter placements from the OR to the ICU bedside
Design: Prospective non-randomized, observational study. Working group made up of 36 health care professionals and ancillary staff. Developed guidelines for transitioning to bedside procedures, ensuring proper oversight, data collection on procedures, medical staff credentialing and QA monitoring. In-service education provided prior to the start of the procedures. New system implemented in May, 2004.
Setting: Tertiary Care ICU
Patients: 75 procedures on 52 patients. May 2004 - April 2005
Interventions: PEG (22), Trach(34), and IVC filter(19) placed in ICU.
Main Outcome Measures: complications, staff and provider satisfaction (Likert scale 1-5, 6 items Very satisfied =1, very unsatisfied = 5), financial impact to institution.(cost savings).
Results:Complications = 7.84%/pt, 5.33%/procedure (1 pneumothorax, 1 pt pulled PEG. 1 equipment malfunction, 1 minor technical error, 0 deaths). Staff Satisfaction(1’s &2’s) = 72% Overall. Financial impact = Reduction in indirect costs of 18%, reduction in direct costs 0.21%.
Conclusions: Using a multidisciplinary hospital team allows for safe transition of procedures from the OR to the ICU in a tertiary care center. Staff (clinical and ancillary)are satisfied with doing procedures in the ICU. Institutional cost margin can be improved.

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