Sustained Improvement in Tracheal Intubation Safety Across a 15-Center Quality-Improvement Collaborative: An Interventional Study From the National Emergency Airway Registry for Children Investigators
| Autor: | Melinda Register, Kyle J Rehder, Akira Nishisaki, Ronald C. Sanders, Matthew Pinto, Michelle Adu-Darko, Alberto Orioles, Dennis W. Simon, Serena P. Kelly, Keiko M. Tarquinio, G. Kris Bysani, Vicki L. Montgomery, Simon Li, Calvin A. Brown, Asha Shenoi, David Tellez, Natalie Napolitano, Joy D. Howell, Anthony Lee, Vinay M. Nadkarni, Ilana Harwayne-Gidansky, Justine Shults, Conrad Krawiec, Sholeen Nett |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Databases Factual medicine.medical_treatment Critical Illness Critical Care and Intensive Care Medicine Intensive Care Units Pediatric law.invention 03 medical and health sciences 0302 clinical medicine law Outcome Assessment Health Care Intubation Intratracheal Medicine Intubation Humans Registries Risk factor Adverse effect Child business.industry Tracheal intubation 030208 emergency & critical care medicine Odds ratio Intensive care unit Quality Improvement Respiration Artificial Checklist 030228 respiratory system Child Preschool Emergency medicine Female business Airway Emergency Service Hospital |
| Zdroj: | Critical care medicine. 49(2) |
| ISSN: | 1530-0293 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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