We report results from a survey of members of the Society of Critical Care Medicine to assess ICU clinicians’ perceptions of artificial airway safety practices and unplanned extubation (UE) prevention. The survey was distributed between January and February 2024 and received 518 responses (68.5% response rate), with 87.5% from adult ICUs and 12.5% from Pediatric ICUs. Only 48% of adult ICU respondents tracked UE, compared with 73% tracking pressure injuries. Most respondents did not consider UE a “never event,” with over half viewing it as unavoidable. In adult ICUs, delirium was ranked as the highest UE risk factor, and commercial securement devices were the primary endotracheal tube securement method (75.2%). Significant variations were observed in artificial airway management practices and responsibility assignments across ICU settings. The results highlight substantial disparities in airway safety management beliefs and practices, underscoring the need for standardized, evidence-based guidelines.

Background: Preoperative patient evaluation and optimization in a preoperative evaluation center (PEC) has been shown to improve operating room (OR) efficiency and patient care. However, performing preoperative evaluation on all patients scheduled for surgery or procedure would be time- and resource-consuming. Therefore, appropriate patient selection for evaluation at PECs is one aspect of improving PEC efficiency. In this study, we evaluate the effect of an enhanced preoperative evaluation process (PEP), utilizing a nursing triage phone call and information technology (IT) optimizations, on PEC efficiency and the quality of care in bariatric surgery patients. We hypothesized that, compared to a traditional PEP, the enhanced PEP would improve PEC efficiency without a negative impact on quality. Methods: The study was a retrospective cohort analysis of 1550 patients from January 2014 to March 2017 at a large, tertiary care academic health system. The study was a before/after comparison that compared the enhanced PEP model to the traditional PEP model. The primary outcome was the efficiency of the PEC, which was measured by the reduction of in-person patient visits at the PEC. The secondary outcome was the quality of care, which was measured by delays, cancellations, and the need for additional testing on the day of surgery (DOS). Results: The enhanced PEP improved the primary outcome of efficiency, as evident by an 80% decrease in in-person patient visits to the PEC. There was no reduction in the secondary outcome of the quality of care as measured by delays, cancellations, or the need for additional testing on the DOS. The implementation of the enhanced PEP did not result in increased costs or resource utilization. Conclusions: The enhanced PEP in a multi-disciplinary preoperative process can improve the efficiency of PEC for bariatric surgery patients without any decrease in the quality of care. The enhanced PEP process can be implemented without an increase in resource utilization and can be particularly useful during the COVID-19 pandemic.

Safe and effective delivery of IV sedatives and anesthetics for Out of Operating Room Anesthesia (OORA) is based on the same principles that govern delivery of these medications in the OR settings, while taking into account the unique conditions imposed by the diverse environments of each of the procedural locations. This entails understanding, and implementing, all applicable scientific, technological, regulatory, and organizational principles in order to enhance patient safety and operational efficiency. Delivering OORA poses physical and operational constraints, in the forms of limited lighting; excessive noise; limited access by the clinician to the patient; and limited devise allowance into OORA sites, e.g., MRI suite; disorganized scheduling and inadequate patient preparation. The benefits of understanding operational principles of OORA extend to OR and ICU settings as many OR suites are becoming increasingly hybrid environments, e.g., OR MRI or OR-bi-plane angiography, and OR electrophysiology; and as many procedures are performed in ICU settings, e.g., percutaneous tracheotomy tube insertion and percutaneous endoscopic gastrostomy (PEG) tube insertions. The portability and versatility of IV anesthetics and sedatives make them particularly suitable choices for OORA. Technological advances in drug delivery of IV anesthetic and sedatives, in the forms of programmable drug delivery devices, and target-controlled infusion (TCI) systems, enhance the utility of IV anesthetics and sedatives in the OORA environment and extends as well to the OR and intensive care units (ICU).