A quality improvement initiative to increase the safety of pediatric emergency airway management
| Autor: | Domenic R Cincotta, Elliot Long, Joanne Grindlay, Emmanuelle Fauteux-Lamarre, Stefano Sabato, David Beckerman, Nuala Quinn, Terry Carroll |
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| Rok vydání: | 2017 |
| Předmět: |
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 |
| Zdroj: | Pediatric Anesthesia. 27:1271-1277 |
| ISSN: | 1155-5645 |
| DOI: | 10.1111/pan.13275 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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