Latest news with #operatingroom
Medscape
28-07-2025
- Health
- Medscape
ED Intubation May Raise Mortality Risk in Active Hemorrhage
TOPLINE: In a cohort study of patients with active hemorrhage, endotracheal intubation in the emergency department (ED) was associated with higher mortality rates, more frequent ICU admissions, and a greater need for blood transfusion compared with intubation in the operating room (OR). METHODOLOGY: Researchers conducted a nationwide, retrospective cohort analysis using data from the Israel National Trauma Registry between 2013 and 2023. A total of 1527 patients (median age, 29 years; 89.6% men) who required transfer to the OR for hemorrhage control surgery within 90 minutes of ED arrival were included. A total of 279 participants underwent endotracheal intubation in the ED and 1248 were intubated upon arrival in the OR. Indications for immediate intubation in the ED included having a Glasgow Coma Scale score < 9 or serious injuries (Abbreviated Injury Score [AIS] ≥ 3) to the head, face, neck, or thorax. The primary outcome was survival to hospital discharge for patients with an Injury Severity Score (ISS) > 14, and secondary outcomes included blood transfusion requirements and ICU admission following hemorrhage control procedures. Patients were followed up until discharge from their respective trauma care centers, and potential confounders included age, sex, systolic blood pressure on admission, ISS, and blunt vs penetrating trauma. TAKEAWAY: Patients intubated in the ED had higher in-hospital mortality (5.0% vs 0.5%; P < .001), higher ICU admission rates (63.1% vs 28.9%; P < .001), and a greater need for blood transfusion in the ED (49.8% vs 15.0%; P < .001) than those intubated in the OR. After adjustment for confounders, ED intubation was independently associated with increased mortality (adjusted odds ratio [aOR], 5.01; P = .006). In the matched cohort, ED intubation trended toward higher mortality (8.0% vs 2.9%; aOR, 3.10; P = .065) Among the patients intubated in the ED, 44.1% were hospitalized for 14 or more days, whereas 19.6% of those intubated in the OR were hospitalized for the same duration ( P < .001). For the whole cohort, intubation in the ED was independently associated with increased ICU admission (aOR, 3.17; P < .001) and a greater need for blood product transfusion (aOR, 4.81; P < .001). IN PRACTICE: "Trauma [care] providers should prioritize blood-based resuscitation to optimize the patient's physiology before proceeding with intubation, while also minimizing delays to definitive care in the OR. Airway management, particularly in the ED, should be performed only when there is a clear indication and, whenever possible, after the patient has been physiologically optimized," the authors wrote. SOURCE: The study was led by Danny Epstein, Rambam Health Care Campus, Haifa, Israel. It was published online on June 14, 2025, in The American Journal of Emergency Medicine. LIMITATIONS: The study was limited by incomplete registry data on the specific clinical indications and timing of ED intubations. The exact factors contributing to mortality could not be determined, and the exclusion of patients who died before reaching the OR may have led to underestimated mortality rates. Additionally, the registry did not capture patient comorbidities, which could have influenced hemodynamic stability and intubation-related complications. DISCLOSURES: The authors reported no funding sources or relevant conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Fast Company
04-06-2025
- Health
- Fast Company
Can healthcare go green without compromising safety?
U.S. hospitals generate nearly six million tons of waste each year, and a single patient can be responsible for more than 30 pounds a day. Much of that waste comes from the operating room (OR), which accounts for up to a third of a hospital's total output and is among the most expensive areas to manage. A large portion comes from single-use devices, packaging, and transport materials. These practices are often criticized, and not without reason. But in settings like transplantation, much of that waste is directly tied to protecting patients. I'm often asked, 'Why not make devices reusable?' or 'What about the environmental impact?' After years in the OR and working alongside transplant teams, I've asked those same questions. The answers aren't black and white, but that doesn't mean we should stop asking. Sustainability often gets reduced to packaging claims or material swaps. But the real impact lies in the systems we build around the product. That's the conversation we need to be having. Why single-use still matters Some of the industry's most criticized practices, like single-use devices, are also the least negotiable. Single-use eliminates the need for sterilization between uses, simplifies prep and cleanup, and reduces the risk of infection. The FDA permits reprocessing of certain single-use tools, but only under strict conditions. Nowhere is that margin tighter than in organ transplantation. There are no do-overs when you're handling a human organ. Transplant patients are especially vulnerable to infection due to immunosuppression, and even small lapses in sterility can lead to serious complications. Device-associated infections, from central lines, catheters, and ventilators, are among the most common and serious complications following transplant. The CDC also notes that while concerns persist about reusing single-use devices, more research is needed to define the risks. Devices that reduce infection risk and prevent complications can lead to fewer readmissions, which means fewer hospital resources used and better sustainability over time. The systems around the product Many conversations about sustainability start and stop with the product itself, whether it's recyclable, biodegradable, or made with 'green' materials. But many of the most wasteful decisions happen in how a product moves through the system that supports it. And when that system spans hospitals, suppliers, procurement teams, and legal departments, it's not built for fast change. Even when the intention is there, funding constraints, liability concerns, and the challenge of making changes across large networks often stand in the way. While a fragmented system can't solve the footprint of a single device, medical device companies still have control over how their products are moved and managed, and that's where meaningful change can start. Flying devices around the world might be fast, but it adds unnecessary emissions to an already resource-intensive process. And it's often done not because it's needed, but because it's familiar. Shifting to road transport takes more coordination, but it significantly cuts emissions and gives teams more control over when and how products arrive. What happens after delivery matters just as much. Without a plan for how products are returned, stocked, or moved, operations can shift into reaction mode. That's when waste shows up through emergency shipments, over-ordering, and unused inventory. In kidney transplant, for example, reusable machine perfusion systems have improved outcomes, but broader use has revealed logistical friction, including turnaround delays and higher discard rates. Inefficient habits tend to stay hidden until the consequences catch up. For years, private air travel has been the default in time-sensitive cases, but it comes with a steep environmental cost. At my current company, our team found that one chartered jet can emit as much carbon as manufacturing 200 single-use medical devices. With better planning, commercial flights can often meet the same clinical timelines and reduce emissions without compromising care. Sustainability has to show up in the operational decisions because if the systems around the product are wasteful, it doesn't matter how recyclable the product is. Recyclability won't negate the carbon footprint of wasteful shipping, inefficient production, or reactive inventory habits. A product isn't sustainable if it arrives on a private jet, was rushed through the supply chain, or sits unused on a shelf. Sustainability starts with better questions Healthcare won't eliminate waste entirely. But small changes matter. Reducing reliance on private air travel. Avoiding emergency shipments. Moving production closer to where products are used. None of it sounds radical. But over time, it adds up. And more often than not, it comes down to refusing to accept waste as the cost of doing business. For healthcare leaders, it's worth stepping back to examine the systems tied to a product and where a few deliberate improvements could make an impact. Not every change requires an overhaul. But the right operational shift, at the right point in the process, can reduce waste without ever touching the safety of patient care. And if enough companies commit to that kind of thinking, that's how you move an industry forward.
