Benchmarking Hospital Practices and Policies on Intrahospital Neurocritical Care Transport: The Safe-Neuro-Transport Study

Kapil G. Zirpe, Neurotrauma Unit, Ruby Hall Clinic, Pune 411040, India.
Bhunyawee Alunpipatthanachai, Bhunyawee Alunpipatthanachai, Bhumibol Adulyadej Hospital, Bangkok 10220, Thailand.
Nassim Matin, Neurocritical Care Service, Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA.
Bernice G. Gulek, Neurocritical Care Service, Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA.
Patricia A. Blissitt, Harborview Medical Center, University of Washington School of Nursing, Seattle, WA 98104, USA.
Katherine Palmieri, Department of Anesthesiology, University of Kansas Health System, Kansas City, KS 66160, USA.
Kathryn Rosenblatt, Department of Anesthesiology, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
Umeshkumar Athiraman, Department of Anesthesiology, Washington University, St. Louis, MO 63130, USA.
Suneeta Gollapudy, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Marie Angele Theard, Department of Anesthesiology and Pain Medicine, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, WA 98122, USA.
Sarah Wahlster, Neurocritical Care Service, Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA 98104, USA.
Monica S. Vavilala, Department of Anesthesiology and Pain Medicine, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, WA 98122, USA.
Abhijit V. Lele, Neurocritical Care Service, Department of Anesthesiology and Pain Medicine, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, WA 98122, USA.
Safe-Neuro-Transport Collaborators

Document Type

Article

Abstract

An electronic survey was administered to multidisciplinary neurocritical care providers at 365 hospitals in 32 countries to describe intrahospital transport (IHT) practices of neurocritically ill patients at their institutions. The reported IHT practices were stratified by World Bank country income level. Variability between high-income (HIC) and low/middle-income (LMIC) groups, as well as variability between hospitals within countries, were expressed as counts/percentages and intracluster correlation coefficients (ICCs) with a 95% confidence interval (CI). A total of 246 hospitals (67% response rate; = 103, 42% HIC and = 143, 58% LMIC) participated. LMIC hospitals were less likely to report a portable CT scanner (RR 0.39, 95% CI [0.23; 0.67]), more likely to report a pre-IHT checklist (RR 2.18, 95% CI [1.53; 3.11]), and more likely to report that intensive care unit (ICU) physicians routinely participated in IHTs (RR 1.33, 95% CI [1.02; 1.72]). Between- and across-country variation were highest for pre-IHT external ventricular drain clamp tolerance (reported by 40% of the hospitals, ICC 0.22, 95% CI 0.00-0.46) and end-tidal carbon dioxide monitoring during IHT (reported by 29% of the hospitals, ICC 0.46, 95% CI 0.07-0.71). Brain tissue oxygenation monitoring during IHT was reported by only 9% of the participating hospitals. An IHT standard operating procedure (SOP)/hospital policy (HP) was reported by 37% ( = 90); HIC: 43% (= 44) vs. LMIC: 32% ( = 46), = 0.56. Amongst the IHT SOP/HPs reviewed ( = 13), 90% did not address the continuation of hemodynamic and neurophysiological monitoring during IHT. In conclusion, the development of a neurocritical-care-specific IHT SOP/HP as well as the alignment of practices related to the IHT of neurocritically ill patients are urgent unmet needs. Inconsistent standards related to neurophysiological monitoring during IHT warrant in-depth scrutiny across hospitals and suggest a need for international guidelines for neurocritical care IHT.

Publication Date

4-28-2023

Publication Title

Journal of clinical medicine

ISSN

2077-0383

Volume

12

Issue

9

PubMed ID

37176625

Digital Object Identifier (DOI)

10.3390/jcm12093183

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