Late arrivals necessitate setting up 24/7 protocol
Emergency surgeries generally need extra time
Some unanticipated factors had to be addressed when Pauletta Thomas, RN, senior nursing executive in the Cardiac Special Services department of Fort Sanders Parkwest Medical Center in Knoxville, TN, and her team were attempting to institute six-hour extubation for their open-heart patients.
Since urgent and emergent patients as well as elective cases were incorporated in the project, they had to deal with the problem of patients who come back from surgery late in the afternoon. "How were we going to get them extubated in the time we had set as our goal?" Thomas says. "The patients we extubated earlier in the day were doing so well."
Dealing with late afternoon surgeries
To address that issue the team established a protocol that they could use 24 hours a day, seven days a week. "It has worked very well," Thomas says. "We’ve had one or two reintubations, but they were primarily due to rhythm problems rather than the quick extubation."
Debra Caskey, RN, administrative director of cardiovascular services for The Jewish Health System of Cincinnati, says while her facility usually extubates within six hours, they do "venture away from it occasionally, and that tends to be for cases that come out late in the day. At night, the hospital doesn’t have as many resources around in case a patient gets into trouble and had to be reintubated."
Typically, the night staff covers obstetrics, and if a case develops, they become unavailable. "Then you might have to rely upon one of the residents to do the reintubation," she explains. "We’ve tracked those late comers and determined that keeping them intubated doesn’t add to our length of stay in the ICU. Also, our late day cases tend to be emergency surgeries, and they are typically a little sicker than the elective patients."
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