Toby Fogg1,2,3, Hatem Alkhouri4, John Vassiliadis1,3,5. 1. Emergency Department, Royal North Shore Hospital, Sydney, New South Wales, Australia. 2. CareFlight, Sydney, New South Wales, Australia. 3. Discipline of Emergency Medicine, Sydney University Medical School, Sydney, New South Wales, Australia. 4. Emergency Care Institute, Agency for Clinical Innovation, Sydney, New South Wales, Australia. 5. Sydney Clinical Skills and Simulation Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Abstract
OBJECTIVE: We aim to investigate whether a bundle of changes made to the practice of endotracheal intubation in our ED was associated with an improvement in first pass success rate and a reduction in the incidence of complications. METHODS: We used a prospective observational study. RESULTS: The data on 360 patients who were intubated during an 18-month period following the introduction of these changes were compared with our previously published observational data. Success on first attempt at intubation improved 83.4% to 93.9% (P < 0.0001). The proportion of patients with one or more complication fell from 29.0% to 19.4% (P < 0.042). Oesophageal intubation fell from 4.0% to 0.3% (P < 0.001), and there was a non-significant reduction in the rate of desaturation, from 15.6% to 10.9% (P < 0.07). CONCLUSION: We have shown that, through the introduction of a bundle of changes that spans the domains of staff training, equipment and practice standardisation, we have made significant improvements in the safety of patients undergoing endotracheal intubation in our ED.
OBJECTIVE: We aim to investigate whether a bundle of changes made to the practice of endotracheal intubation in our ED was associated with an improvement in first pass success rate and a reduction in the incidence of complications. METHODS: We used a prospective observational study. RESULTS: The data on 360 patients who were intubated during an 18-month period following the introduction of these changes were compared with our previously published observational data. Success on first attempt at intubation improved 83.4% to 93.9% (P < 0.0001). The proportion of patients with one or more complication fell from 29.0% to 19.4% (P < 0.042). Oesophageal intubation fell from 4.0% to 0.3% (P < 0.001), and there was a non-significant reduction in the rate of desaturation, from 15.6% to 10.9% (P < 0.07). CONCLUSION: We have shown that, through the introduction of a bundle of changes that spans the domains of staff training, equipment and practice standardisation, we have made significant improvements in the safety of patients undergoing endotracheal intubation in our ED.
Authors: Christopher J Groombridge; Amit Maini; Alexander Olaussen; Yesul Kim; Mark Fitzgerald; De Villiers Smit Journal: Emerg Med Australas Date: 2021-06-02 Impact factor: 2.279