Akira Nishisaki1, Anthony Lee2, Simon Li3, Ronald C Sanders4, Calvin A Brown5, Kyle J Rehder6, Natalie Napolitano7, Vicki L Montgomery8, Michelle Adu-Darko9, G Kris Bysani10, Ilana Harwayne-Gidansky11, Joy D Howell12, Sholeen Nett13, Alberto Orioles14, Matthew Pinto3, Asha Shenoi15, David Tellez16, Serena P Kelly17, Melinda Register18, Keiko Tarquinio19, Dennis Simon20, Conrad Krawiec21, Justine Shults22, Vinay Nadkarni1. 1. Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA. 2. Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, OH. 3. Department of Pediatrics, Division of Pediatric Critical Care Medicine, Maria Fareri Children's Hospital, Valhalla, NY. 4. Section of Critical Care, Department of Pediatrics, Arkansas Children's Hospital, Little Rock, AR. 5. Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. 6. Division of Pediatric Critical Care, Department of Pediatrics, Duke Children's Hospital, Durham, NC. 7. Department of Respiratory Therapy, Children's Hospital of Philadelphia, Philadelphia, PA. 8. Division of Pediatric Critical Care, University of Louisville and Norton Children's Hospital, Louisville, KY. 9. Division of Critical Care, Children's Hospital of the University of Virginia, Charlottesville, VA. 10. Pediatric Critical Care Medicine, Pediatric Acute Care Associates of North Texas PLLC, Medical City Children's Hospital, Dallas, TX. 11. Division of Critical Care, Stony Brook Children's Hospital, Stony Brook, NY. 12. Department of Pediatrics, New York-Presbyterian Weill Cornell Medical Center, New York, NY. 13. Division of Pediatric Critical Care, Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, NH. 14. Division of Critical Care, Children's Hospital and Clinics of Minnesota, Minneapolis, MN. 15. Department of Pediatrics, Division of Pediatric Critical Care, Kentucky Children's Hospital, University of Kentucky School of Medicine, Lexington, KY. 16. Pediatric Critical Care Medicine, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ. 17. Division of Pediatric Critical Care Medicine, Doernbecher Children's Hospital, Portland, OR. 18. Department of Respiratory Therapy, Children's Healthcare of Atlanta, Atlanta, GA. 19. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta GA. 20. Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. 21. Division of Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children's Hospital, Pennsylvania State University College of Medicine, Hershey, PA. 22. Department of Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Abstract
OBJECTIVES: To evaluate the effect of a tracheal intubation safety bundle on adverse tracheal intubation-associated events across 15 PICUs. DESIGN: Multicenter time-series study. SETTING: PICUs in the United States. PATIENTS: All patients received tracheal intubations in ICUs. INTERVENTIONS: We implemented a tracheal intubation safety bundle as a quality-improvement intervention that includes: 1) quarterly site benchmark performance report and 2) airway safety checklists (preprocedure risk factor, approach, and role planning, preprocedure bedside "time-out," and immediate postprocedure debriefing). We define each quality-improvement phase as baseline (-24 to -12 mo before checklist implementation), benchmark performance reporting only (-12 to 0 mo before checklist implementation), implementation (checklist implementation start to time achieving > 80% bundle adherence), early bundle adherence (0-12 mo), and sustained (late) bundle adherence (12-24 mo). Bundle adherence was defined a priori as greater than 80% of checklist use for tracheal intubations for 3 consecutive months. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the adverse tracheal intubation-associated event, and secondary outcomes included severe tracheal intubation-associated events, multiple tracheal intubation attempts, and hypoxemia less than 80%.From January 2013 to December 2015, out of 19 participating PICUs, 15 ICUs (79%) achieved bundle adherence. Among the 15 ICUs, the adverse tracheal intubation-associated event rates were baseline phase: 217/1,241 (17.5%), benchmark reporting only phase: 257/1,750 (14.7%), early 0-12 month complete bundle compliance phase: 247/1,591 (15.5%), and late 12-24 month complete bundle compliance phase: 137/1,002 (13.7%). After adjusting for patient characteristics and clustering by site, the adverse tracheal intubation-associated event rate significantly decreased compared with baseline: benchmark: odds ratio, 0.83 (0.72-0.97; p = 0.016); early bundle: odds ratio, 0.80 (0.63-1.02; p = 0.074); and late bundle odds ratio, 0.63 (0.47-0.83; p = 0.001). CONCLUSIONS: Effective implementation of a quality-improvement bundle was associated with a decrease in the adverse tracheal intubation-associated event that was sustained for 24 months.
OBJECTIVES: To evaluate the effect of a tracheal intubation safety bundle on adverse tracheal intubation-associated events across 15 PICUs. DESIGN: Multicenter time-series study. SETTING: PICUs in the United States. PATIENTS: All patients received tracheal intubations in ICUs. INTERVENTIONS: We implemented a tracheal intubation safety bundle as a quality-improvement intervention that includes: 1) quarterly site benchmark performance report and 2) airway safety checklists (preprocedure risk factor, approach, and role planning, preprocedure bedside "time-out," and immediate postprocedure debriefing). We define each quality-improvement phase as baseline (-24 to -12 mo before checklist implementation), benchmark performance reporting only (-12 to 0 mo before checklist implementation), implementation (checklist implementation start to time achieving > 80% bundle adherence), early bundle adherence (0-12 mo), and sustained (late) bundle adherence (12-24 mo). Bundle adherence was defined a priori as greater than 80% of checklist use for tracheal intubations for 3 consecutive months. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the adverse tracheal intubation-associated event, and secondary outcomes included severe tracheal intubation-associated events, multiple tracheal intubation attempts, and hypoxemia less than 80%.From January 2013 to December 2015, out of 19 participating PICUs, 15 ICUs (79%) achieved bundle adherence. Among the 15 ICUs, the adverse tracheal intubation-associated event rates were baseline phase: 217/1,241 (17.5%), benchmark reporting only phase: 257/1,750 (14.7%), early 0-12 month complete bundle compliance phase: 247/1,591 (15.5%), and late 12-24 month complete bundle compliance phase: 137/1,002 (13.7%). After adjusting for patient characteristics and clustering by site, the adverse tracheal intubation-associated event rate significantly decreased compared with baseline: benchmark: odds ratio, 0.83 (0.72-0.97; p = 0.016); early bundle: odds ratio, 0.80 (0.63-1.02; p = 0.074); and late bundle odds ratio, 0.63 (0.47-0.83; p = 0.001). CONCLUSIONS: Effective implementation of a quality-improvement bundle was associated with a decrease in the adverse tracheal intubation-associated event that was sustained for 24 months.
Authors: Elizabeth K Laverriere; John E Fiadjoe; Nancy McGowan; Benjamin B Bruins; Natalie Napolitano; Ichiro Watanabe; Nicole K Yamada; Catharine M Walsh; Robert A Berg; Vinay M Nadkarni; Akira Nishisaki Journal: Paediatr Anaesth Date: 2022-06-24 Impact factor: 2.129
Authors: A Fuchs; S Frick; M Huber; T Riva; L Theiler; M Kleine-Brueggeney; T H Pedersen; J Berger-Estilita; R Greif Journal: Anaesthesia Date: 2022-03-18 Impact factor: 12.893
Authors: Uri Pollak; Yael Feinstein; Candace N Mannarino; Mary E McBride; Malaika Mendonca; Eitan Keizman; David Mishaly; Grace van Leeuwen; Peter P Roeleveld; Lena Koers; Darren Klugman Journal: Front Pediatr Date: 2022-09-16 Impact factor: 3.569