Melzer Jonathan M, Hamersley Erin R S, Gallagher Thomas Q
1 Department of Otolaryngology-Head and Neck Surgery, Naval Hospital Naples, Gricignano di Aversa, Italy.
2 Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA.
Otolaryngol Head Neck Surg. 2017 Jun;156(6):1048-1053. doi: 10.1177/0194599817697046. Epub 2017 Apr 18.
Objective Development of a novel pediatric airway kit and implementation with simulation to improve resident response to emergencies with the goal of improving patient safety. Methods Prospective study with 9 otolaryngology residents (postgraduate years 1-5) from our tertiary care institution. Nine simulated pediatric emergency airway drills were carried out with the existing system and a novel portable airway kit. Response times and time to successful airway control were noted with both the extant airway system and the new handheld kit. Results were analyzed to ensure parametric data and compared with t tests. A Bonferroni adjustment indicated that an alpha of 0.025 was needed for significance. Results Use of the airway kit significantly reduced the mean time of resident arrival by 47% ( P = .013) and mean time of successful intubation by 50% ( P = .007). Survey data indicated 100% improved resident comfort with emergent airway scenarios with use of the kit. Discussion Times to response and meaningful intervention were significantly reduced with implementation of the handheld airway kit. Use of simulation training to implement the new kit improved residents' comfort and airway skills. This study describes an affordable novel mobile airway kit and demonstrates its ability to improve response times. Implications for Practice The low cost of this airway kit makes it a tenable option even for smaller hospitals. Simulation provides a safe and effective way to familiarize oneself with novel equipment, and, when possible, realistic emergent airway simulations should be used to improve provider performance.
目的 开发一种新型儿科气道套件，并通过模拟实施该套件，以改善住院医师对紧急情况的应对能力，目标是提高患者安全性。方法 对来自我们三级医疗机构的9名耳鼻喉科住院医师（研究生1至5年级）进行前瞻性研究。使用现有系统和一种新型便携式气道套件进行了9次模拟儿科紧急气道演练。记录使用现有气道系统和新手持套件时的响应时间和成功控制气道的时间。对结果进行分析以确保参数数据，并与t检验进行比较。Bonferroni校正表明，显著性需要α值为0.025。结果 使用气道套件显著缩短了住院医师到达的平均时间47%（P = 0.013），成功插管的平均时间缩短了50%（P = 0.007）。调查数据表明，使用该套件后，住院医师在紧急气道场景中的舒适度提高了100%。讨论 实施手持式气道套件后，响应时间和有效干预时间显著缩短。使用模拟训练来实施新套件提高了住院医师的舒适度和气道技能。本研究描述了一种经济实惠的新型移动气道套件，并展示了其缩短响应时间的能力。对实践的启示 这种气道套件成本低，即使对于较小的医院也是一个可行的选择。模拟提供了一种安全有效的方式来熟悉新设备，并且在可能的情况下，应使用逼真的紧急气道模拟来提高医疗人员的表现。
