Elliot Long1,2,3, Domenic R Cincotta1,2,3, Joanne Grindlay1,2,3, Stefano Sabato2,4, Emmanuelle Fauteux-Lamarre1,2, David Beckerman1,5, Terry Carroll1,4,5, Nuala Quinn1. 1. Department of Emergency Medicine, The Royal Children's Hospital, Parkville, Vic., Australia. 2. Murdoch Children's Research Institute, Parkville, Vic., Australia. 3. Department of Pediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville, Vic., Australia. 4. Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Parkville, Vic., Australia. 5. Department of Nursing, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Parkville, Vic., Australia.
Abstract
BACKGROUND: Emergency airway management is commonly associated with life-threatening hypoxia and hypotension which may be preventable. AIMS: The aim of this quality improvement study was to reduce the frequency of intubation-related hypoxia and hypotension. METHODS: This prospective quality improvement study was conducted over 4 years in the Emergency Department of The Royal Children's Hospital, Melbourne, Australia. A preintervention cohort highlighted safety gaps and was used to design study interventions, including an emergency airway algorithm, standardized airway equipment, a preintubation checklist and equipment template, endtidal carbon dioxide monitoring, postintubation team debriefing, and multidisciplinary team training. Following implementation, a postintervention cohort was used to monitor the impact of study interventions on clinical process and patient outcome. Process measures were as follows: use of a preintubation checklist, verbalization of an airway plan, adequate resuscitation prior to intubation, induction agent dose titration, use of apneic oxygenation, and use of endtidal carbon dioxide to confirm endotracheal tube position. The primary outcome measure was first pass success rate without hypoxia or hypotension. Potential harms from study interventions were monitored. RESULTS: Forty-six intubations were included over one calendar year in the postintervention cohort (compared to 71 in the preintervention cohort). Overall clinical uptake of the 6 processes measures was 85%. First pass success rate without hypoxia or hypotension was 78% in the postintervention cohort compared with 49% in the preintervention cohort (absolute risk reduction: 29.0%; 95% confidence interval 12.3%-45.6%, number needed to treat: 3.5). No significant harms from study interventions were identified. CONCLUSION: Quality improvement initiatives targeting emergency airway management may be successfully implemented in the emergency department and are associated with a reduction in adverse intubation-related events.
BACKGROUND: Emergency airway management is commonly associated with life-threatening hypoxia and hypotension which may be preventable. AIMS: The aim of this quality improvement study was to reduce the frequency of intubation-related hypoxia and hypotension. METHODS: This prospective quality improvement study was conducted over 4 years in the Emergency Department of The Royal Children's Hospital, Melbourne, Australia. A preintervention cohort highlighted safety gaps and was used to design study interventions, including an emergency airway algorithm, standardized airway equipment, a preintubation checklist and equipment template, endtidal carbon dioxide monitoring, postintubation team debriefing, and multidisciplinary team training. Following implementation, a postintervention cohort was used to monitor the impact of study interventions on clinical process and patient outcome. Process measures were as follows: use of a preintubation checklist, verbalization of an airway plan, adequate resuscitation prior to intubation, induction agent dose titration, use of apneic oxygenation, and use of endtidal carbon dioxide to confirm endotracheal tube position. The primary outcome measure was first pass success rate without hypoxia or hypotension. Potential harms from study interventions were monitored. RESULTS: Forty-six intubations were included over one calendar year in the postintervention cohort (compared to 71 in the preintervention cohort). Overall clinical uptake of the 6 processes measures was 85%. First pass success rate without hypoxia or hypotension was 78% in the postintervention cohort compared with 49% in the preintervention cohort (absolute risk reduction: 29.0%; 95% confidence interval 12.3%-45.6%, number needed to treat: 3.5). No significant harms from study interventions were identified. CONCLUSION: Quality improvement initiatives targeting emergency airway management may be successfully implemented in the emergency department and are associated with a reduction in adverse intubation-related events.
Authors: Erin F Hoehn; Preston Dean; Andrew J Lautz; Mary Frey; Mary K Cabrera-Thurman; Gary L Geis; Erika Stalets; Matthew Zackoff; Tena Pham; Andrea Maxwell; Adam Vukovic; Benjamin T Kerrey Journal: Pediatr Qual Saf Date: 2020-10-26
Authors: Berkeley L Bennett; Daniel Scherzer; Delia Gold; Don Buckingham; Andrew McClain; Elaise Hill; Adjoa Andoh; Joseph Christman; Andrew Shonk; Sandra P Spencer Journal: Pediatr Qual Saf Date: 2020-09-25