Impact of a targeted bundle of audit with tailored education and an intubation checklist to improve airway management in the emergency department: an integrated time series analysis
| Autor: | De Villiers Smit, Biswadev Mitra, Christopher Groombridge, Alexander Olaussen, Yen Kim, Mark Fitzgerald, Amit Maini |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Victoria medicine.medical_treatment Audit Critical Care and Intensive Care Medicine 03 medical and health sciences 0302 clinical medicine Trauma Centers Intubation Intratracheal medicine Humans Intubation Prospective Studies Registries 030212 general & internal medicine Airway Management business.industry Major trauma Interrupted Time Series Analysis 030208 emergency & critical care medicine General Medicine Emergency department Middle Aged medicine.disease Quality Improvement Checklist Outcome and Process Assessment Health Care Emergency medicine Emergency Medicine Female Airway management Airway business Cohort study |
| Zdroj: | Emergency Medicine Journal. 37:576-580 |
| ISSN: | 1472-0213 1472-0205 |
| DOI: | 10.1136/emermed-2019-208935 |
| Popis: | BackgroundEndotracheal intubation (ETI) is a commonly performed but potentially high-risk procedure in the emergency department (ED). Requiring more than one attempt at intubation has been shown to increase adverse events and interventions improving first-attempt success rate should be identified to make ETI in the ED safer. We introduced and examined the effect of a targeted bundle of airway initiatives on first-attempt success and adverse events associated with ETI.MethodsThis prospective, interventional cohort study was conducted over a 2-year period at an Australian Major Trauma Centre. An online airway registry was established at the inception of the study to collect information related to all intubations. After 6 months, we introduced a bundle of initiatives including monthly audit, monthly airway management education and an airway management checklist. A time series analysis model was used to compare standard practice (ie, first 6 months) to the postintervention period.ResultsThere were 526 patients, 369 in the intervention group and 157 in the preintervention comparator group. A total of 573 intubation attempts were performed. There was a significant improvement in first-attempt success rates between preintervention and postintervention groups (88.5% vs 94.6%, relative risk 1.07; 95% CI 1.00 to 1.14, p=0.014). After the introduction of the intervention the first-attempt success rate increased significantly, by 13.4% (p=0.006) in the first month, followed by a significant increase in the monthly trend (relative to the preintervention trend) of 1.71% (pConclusionsThis bundle of airway management initiatives was associated with significant improvement in the first-attempt success rate of ETI. The introduction of a regular education programme based on the audit of a dedicated airway registry, combined with a periprocedure checklist is a worthwhile ED quality improvement initiative. |
| Databáze: | OpenAIRE |
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