Episode #221 Enhancing Patient Safety in Neurocritical Care: Best Practices for Managing External Ventricular Drains with Dr. Abhijit Lele – Part 2 of 3

September 25, 2024

Subscribe
Share Episode
SHOW NOTES
transcript

Welcome to the next installment of the Anesthesia Patient Safety podcast hosted by Alli Bechtel.  This podcast will be an exciting journey towards improved anesthesia patient safety.

Our featured topic today is the External Ventricular Drain Safety Campaign: A Global Patient Safety Initiative which represents a collaboration between the APSF and The Society for Neuroscience in Anesthesiology and Critical Care. Check it out here.

https://www.apsf.org/evd/

Here are links to the excellent resources that make up the EVD Safety Campaign.

Knowledge Hub:

https://snacc.org/external-ventricular-drain-campaign/

EVD Management Guidelines:

SNACC EVD Guidelines [PDF Download]

EVD Educational Document:
In the year 2017, SNACC’s task force on the perioperative care of patients with external ventricular drains created an educational document. This document can be found below.

EVD Educational Document [PDF Download]

EVD Policy and Procedure Template:
Are you planning to revise your hospital’s policy and procedures regarding EVDs1? An evidence-based policy and procedure template can be found below. Implement best practices with our customizable template.5 The template is based on evidence-based guidelines regarding insertion and maintenance of EVDs.

EVD Policy and Procedure Template [PDF Download]

EVD Quality Metrics: 

Measure and improve EVD management with our metrics.

Are you interested in collecting data on quality and safety regarding EVDs? SNACC has created a list of electronic clinical quality metrics that you can start implementing at your hospital. These metrics are based on the evidence-based recommendations.

EVD Quality Metrics [PDF Download]

How would you like some APSF gear? We have all-new APSF branded vests. You could stay warm while showing your support for the ASPF just by making an annual recurring contribution of $250 or more to the APSF. Plus, these contributions are listed in the quarterly publications of the APSF Newsletter and on the APSF website. Just think you could be wearing an APSF vest while listening to the Anesthesia Patient Safety Podcast. Check it out here.

https://www.apsf.org/donate/

Subscribe to our YouTube Channel here: https://www.youtube.com/@AnesthesiaPatientSafety
Be sure to check out the APSF website at https://www.apsf.org/
Make sure that you subscribe to our newsletter at https://www.apsf.org/subscribe/
Follow us on Twitter @APSForg
Questions or Comments? Email me at [email protected].
Thank you to our individual supports https://www.apsf.org/product/donation-individual/
Be a part of our first crowdfunding campaign https://www.apsf.org/product/crowdfunding-donation/
Thank you to our corporate supporters https://www.apsf.org/donate/corporate-and-community-donors/
Additional sound effects from: Zapsplat.

© 2024, The Anesthesia Patient Safety Foundation

Hello and welcome back to the Anesthesia Patient Safety Podcast. My name is Alli Bechtel, and I am your host. Thank you for joining us for another show. We are returning to the APSF Resources today and the External Ventricular Drain Safety Campaign. Do you provide anesthesia care for patients who may have an EVD in place? What did you do to prepare for the case? We hope that you will use the APSF SNACC EVD Safety Campaign as a resource to stay up to date with the knowledge, skills, and recommendations to keep your patients with EVDs safe during anesthesia care and transport to the ICU.

 

Before we dive into the episode today, we’d like to recognize Medtronic, a major corporate supporter of APSF. Medtronic has generously provided unrestricted support to further our vision that “no one shall be harmed by anesthesia care”. Thank you, Medtronic – we wouldn’t be able to do all that we do without you!”

 

Our featured topic again today is the External Ventricular Drain Safety Campaign: A Global Patient Safety Initiative which represents a collaboration between the APSF and The Society for Neuroscience in Anesthesiology and Critical Care. To follow along with us, head over to APSF.org and click on the Patient Safety Resources heading. Then, the 7th one down is External Ventricular Drain Safety Campaign. I will include a link in the show notes as well.

 

We are so excited to be talking with Abhijit Lele today. He is a neuro-anesthesiologist and neuro-intensivist with an interest in stroke, traumatic brain injury, and quality improvement with numerous publications and projects including being the project manager for the EVD Safety Campaign and the Chair of the Quality and Safety Committee of the Society for Neuroscience in Anesthesiology and Critical Care. He is dedicated to improving global patient safety as we are going to hear. Okay, so what are we waiting for? Here is our conversation now:

 

Interview:

[Bechtel] Hello and welcome to the Anesthesia Patient Safety Podcast. Thank you for taking the time to join us for a show.

 

[Bechtel] If you could just introduce yourself and tell us a little bit about kind of your anesthesia background and how you got to where you are now.

 

[Lele] So, first of all, thank you for having me on the podcast. You know, my name is Abhijit Lele and I’m currently serving as the director of the Neurocritical Care Service at Harborview Medical Center at the University of Washington.  I completed my anesthesia training at St. Barnabas Medical Center in Livingston, New Jersey,  where I developed a deep interest in neuroanesthesia and critical care.

 

And then I pursued a fellowship at Johns Hopkins Medical Institution shortly after my anesthesia residency.  Um, over the years, my career has evolved to focus on neurocritical care, neuroanesthesiology, and kind of the perioperative critical care. area, particularly in the management of complex neurological conditions in the perioperative and intensive care setting.

 

In my current role, I lead a multidisciplinary team dedicated to improving outcomes for patients with severe neurological neurosurgical emergencies. And I’m also involved in various research quality improvement initiative aimed at advancing neurocritical care practices globally.

 

[Bechtel] Was there something during your training or early career that got you really interested in neuroanesthesia  and neurocritical care?

 

[Lele] My interest in neurocritical care initially began during my pediatrics residency where I was, I worked on a thesis, uh, focused on non-traumatic coma in children.

 

This was, this was in India where I did my pediatrics residency. This experience opened my eyes to the complexities and critical nature of neurological conditions. Transcribed especially in vulnerable populations like children. And my interest was then further bolstered during my neuro anesthesia rotation during the anesthesia residency, where I had the opportunity to delve deeper into the management of neurological cases in the operating room and then during the intensive care unit rotations as well.

 

And these experiences combined to fuel my passion for neurocritical care, where I saw this tremendous potential to improve Or make a significant impact on patient outcomes through specialized care and advanced monitoring techniques.

[Bechtel] This Initiative with the APSF is also in conjunction with the Society for Neuroscience and Anesthesiology and Critical Care. Can you tell us a little bit about the work that that society does and who should join the society and anything else about it?

[Lele] So, the Society for Neuroscience in NSUC or SNAC is an organization that brings together professionals dedicated to advancing the care of patients with neurological conditions. The mission of SNAC is to safeguard and optimize perioperative neurological function and brain health through neuroscience research, education, and advocacy, thereby advancing high quality patient centered anesthesia and critical care. SNAC serves as a platform for education, research, quality improvement, and collaboration amongst anesthesiologists, neurointensivists, neuroscientists, and other healthcare providers. The society plays a critical role in promoting best practices and developing guidelines that shape the way we approach neuroanesthesia and neurocritical care.

And being a part of SNAC has allowed me to connect with like-minded professionals and contribute to the ongoing dialogue on improving care for neurologically impaired patients. So as a, as somebody interested in, uh, you know, promoting brain health, if you will, or preserving brain neurological function and improving outcomes.

For our vulnerable patients who are undergoing  surgical procedures who are admitted in the intensive care unit for  neurosurgical neurological emergencies, SNAC would be a great organization to be a part of  as as it promotes the and safeguards in optimizing perioperative neurological functions.  Well, and this external ventricular drain safety campaign is one of the new APSF resources that we are all very excited about.

[Bechtel] Can you tell us a little bit about this campaign and how the initiative started?

[Lele] So the external ventricular drain or EVD safety campaign is an initiative aimed at reducing complications associated with the use of EVDs, which are commonly used in management of conditions such as acute symptomatic hydrocephalus, be it from subarachnoid hemorrhage or intraventricular hemorrhage, intraparenchymal hemorrhage and in patients with traumatic brain injury.

The campaign started as a response to observed variations in practice and the significant risks associated with EVD placement and management, including infection, hemorrhage, misplacement of EV. and also intra hospital transport related complications. One key area we focus on in the campaign is promoting the importance of intracranial pressure monitoring and playing close attention to the EVD clamp status, which can be problematic in certain patients who do not tolerate EVD clamping during intra hospital transports.

Baseline data suggests that anesthesiologists often feel inherently uncomfortable managing EVDs, a responsibility that has historically fallen within the expertise of ICU nurses and neurosurgeons. Given that EVDs are used globally in a wide range of settings and many patients in the operating room, uh, arrive in the operating room with external ventricular drains and other types of intercranial pressure monitors for both neurosurgical and non-neurosurgical procedures, it is vitally important that anesthesiologists  expand their skillset In also understanding the nuances of EVD care in the perioperative area since EVDS are very commonly placed in wide range of settings globally from well-resourced hospitals to those with limited resources, it became clear that establishing standardized practices could have a significant impact on patient outcomes worldwide. And so I’m passionate about this project because it addresses a critical aspect of neurocritical care that affects patients across the globe and by improving patient safety practices, we can reduce preventable complications and ultimately save lives.

[Bechtel] What do you hope to see going forward when it comes to an external ventricular drain safety?

[Lele] Going forward, I hope to see the widespread adoption of standardized protocols and practices for EBD management that are based on, um, you know, um, evidence based guidelines and recommendations, which is also supported by continuous education and training for our healthcare providers in this very operative critical care area.

I envision a future where, uh, EBDs are significantly reduced. And where every healthcare setting, regardless of its resources, has access to knowledge and tools needed to safely manage these devices. Additionally, I would like to see more research into the development of safer EVD technologies and techniques, further minimizing the risks for our patients.

[Bechtel] Great. And what’s next for your research or projects?

[Lele] So in terms of upcoming projects, I’m particularly focused on continuing research into cost effective neurocritical care interventions, particularly in the resource limited environments, um, such as in the low middle income countries and even in high income countries where resources can be limited at times.

Um, I’m also looking to expand the work of the EVD safety campaign by collaborating with international partners to ensure that our guidelines and practices are truly global. Um, and another key area of interest is improving monitoring techniques such as, uh, you know, multimodal neurological monitoring that includes, uh, raw EEG or processed EEG to enhance patient care in the operating room and in the ICU.

[Bechtel] Oh, that’s all really exciting.  And is there anything else that we haven’t talked about today that that you’d like to mention?

[Lele] So I think we’ve covered quite a bit today, but I’d like to add that one of my goals is to ensure that the advancements in neurocritical care are accessible to all, like, regardless of their geographical or economic barriers.

And that’s something that drives much of my work, whether it’s through education, resource, or advocacy.  And I’m also passionate about mentoring the next generation of neurocritical care, neuroanesthesiology specialists, as they will be the ones to carry this field forward and continue to innovate in patient care.

[Bechtel] Towards the end of our conversation, we touched on the topic of global guidelines. Let’s take a listen.

[Lele] Let’s take a listen a global set of guidelines, right, a global set of you know, these recommendations which can be easily adapted to various different environments. But also, you know, acknowledge the tremendous work that practitioners do in areas where the resources are what they are right, and I think you can’t really judge somebody by their not adhering to a specific guideline, because the adherence may not be possible in certain situations. So it’s my, my, what is my emphasis when I’m writing guidelines is to make sure that the, that the network of people that are writing the guidelines, are representative of the global aspects of neurocritical care or neuroanesthesiology and that can be easily then implemented in various different clinical settings. So that is I think it’s an area where I think we still need to do a lot of work to make bring those you know, those recommendation guidelines to a very widely wide population across different countries and hospitals.

[Bechtel] Thank you so much to Lele for joining us on the show today and sharing his experiences. Have you used the EVD Safety Campaign to build or refresh your knowledge yet? We are going to make it easier and dive into the EVD Educational document next week. We will be learning all about EVDs, the indications, complications, management priorities, and troubleshooting tips. We hope that you will tune in.

If you have any questions or comments from today’s show, please email us at [email protected]. Please keep in mind that the information in this show is provided for informational purposes only and does not constitute medical or legal advice. We hope that you will visit APSF.org for detailed information and check out the show notes for links to all the topics we discussed today.

How would you like some APSF gear? We have all-new APSF branded vests. You could stay warm while showing your support for the ASPF just by making an annual recurring contribution of $250 or more to the APSF. That’s right individuals making annual recurring contributions of $250 or greater will receive a free APSF vest. Plus, these contributions are listed in the quarterly publications of the APSF Newsletter and on the APSF website. Check out the Donors page over at apsf.org under the donors heading and I will include a link in the show notes. Just think you could be wearing an APSF vest while listening to the Anesthesia Patient.

Until next time, stay vigilant so that no one shall be harmed by anesthesia care.

© 2024, The Anesthesia Patient Safety Foundation