1. A quality improvement initiative to increase the safety of pediatric emergency airway management
- Author
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Domenic R Cincotta, Elliot Long, Joanne Grindlay, Emmanuelle Fauteux-Lamarre, Stefano Sabato, David Beckerman, Nuala Quinn, and Terry Carroll
- Subjects
Male ,Emergency Medical Services ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,Outcome Assessment, Health Care ,Task Performance and Analysis ,Intubation, Intratracheal ,Humans ,Medicine ,Intubation ,Prospective Studies ,Airway Management ,Child ,Hypoxia ,Intensive care medicine ,Monitoring, Physiologic ,business.industry ,Infant, Newborn ,Absolute risk reduction ,Infant ,030208 emergency & critical care medicine ,Emergency department ,Quality Improvement ,Checklist ,Anesthesiology and Pain Medicine ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Cohort ,Number needed to treat ,Female ,Airway management ,Patient Safety ,Hypotension ,business ,Airway ,Algorithms - Abstract
SummaryBackground 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. Conclusions 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.
- Published
- 2017