title: Transportation of patients following surgery for congenital heart disease: a process review prompted by the opening of a new hospital.
abstract: The decision to extubate the trachea of patients in the operating room prior to transport must balance the relative risks and advantages of transporting patients with an unsecured airway versus the problems associated with maintaining sedation and tracheal intubation during transport. Children with congenital heart disease often benefit from early tracheal extubation and this has been the standard of practice at our institution. However, the recent expansion and opening of a new hospital increased the distance from the cardiac operating rooms to the cardiothoracic intensive care unit and provided an opportunity for us to further evaluate our clinical practice. In order to better understand our practice and prepare for the opening of the new hospital, we conducted a prospective observational quality improvement project to evaluate the hemodynamic and respiratory parameters of postoperative patients undergoing transportation both before and after the move to the new hospital. The study cohort included 115 patients who ranged in age from 2 days to 25 years and in weight from 2.2 to 104 kilograms. Our analysis showed no significant change in our practice of early tracheal extubation. We noted no clinically significant changes in the monitored physiologic variables, despite the increase in the overall transport time. We believe that this transition and the ongoing safety of our practice were facilitated by significant preparation prior to the move including transport simulations.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital Columbus, Ohio ; Department of Anesthesiology and Pain Medicine, The Ohio State University Columbus, Ohio.
authors.forename: Peter
authors.initials: P
authors.lastname: Winch
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital Columbus, Ohio ; Department of Anesthesiology and Pain Medicine, The Ohio State University Columbus, Ohio.
authors.forename: Sarah
authors.initials: S
authors.lastname: Khan
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital Columbus, Ohio ; Department of Anesthesiology and Pain Medicine, The Ohio State University Columbus, Ohio.
authors.forename: Aymen
authors.initials: A
authors.lastname: Naguib
authors.affiliation: Department of Pediatrics, Sections of Cardiology and Critical Care, Nationwide Children's Hospital Columbus, Ohio.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Yates
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital Columbus, Ohio.
authors.forename: Julie
authors.initials: J
authors.lastname: Rice
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital Columbus, Ohio.
authors.forename: N'diris
authors.initials: N
authors.lastname: Barry
authors.affiliation: Department of Cardiothoracic Surgery, The Heart Center, Nationwide Children's Hospital Columbus, Ohio.
authors.forename: Mark
authors.initials: M
authors.lastname: Galantowicz
authors.affiliation: Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital Columbus, Ohio ; Department of Anesthesiology and Pain Medicine, The Ohio State University Columbus, Ohio.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
keywords: Extubation; cardiac surgery; congenital cardiac disease; patient transportation; pediatrics; quality improvement