Neubrand Tara L, Alletag Michelle, Woods Jason, Mendenhall Marcela, Leonard Jan, Schmidt Sarah K
Department of Pediatric Emergency Medicine, University of Colorado, Aurora, CO, USA.
Pediatr Qual Saf. 2019 Nov 19;4(6):e230. doi: 10.1097/pq9.0000000000000230. eCollection 2019 Nov-Dec.
Tracheal intubation is a high-risk procedure in the pediatric emergency department (PED) and pediatric urgent care (PUC) settings. We aimed to develop an airway safety intervention to decrease severe tracheal intubation-associated adverse events (TIAEs) by decreasing process variation.
After gathering baseline data on TIAE, an interdisciplinary team underwent a mini-Delphi process to identify key drivers for decreasing severe TIAE rates. We launched a 4-part airway safety bundle that included: (1) color-coded weight-based equipment chart, (2) visual schematic of airway equipment, (3) recommended medication dosing, and (4) safety checklist across a single, tertiary PED and 5 satellite community PUCs/PEDs. Multiple plan-do-study-act cycles were undertaken, and results were monitored using statistical process control charts. Charts were restaged when special cause variation was achieved. This study aimed to decrease the severe TIAE rate from a baseline of 23% in the tertiary site and 25% in the community sites to <15% within 12 months and to sustain these outcomes for 6 months.
During the study period, we noted decreased rates of severe TIAE in both the PED and PUC setting during the intervention period, and we have sustained this improvement for more than 6 months in all sites with no associated change in balancing measures.
Implementation of an airway safety bundle over a wide geographic area and among personnel with variable levels of training is possible and has the potential to decrease severe TIAE across multiple clinical settings.
气管插管在儿科急诊科（PED）和儿科紧急护理（PUC）环境中是一项高风险操作。我们旨在开发一种气道安全干预措施，通过减少过程变异来降低严重气管插管相关不良事件（TIAEs）。
在收集了TIAE的基线数据后，一个跨学科团队进行了小型德尔菲法流程，以确定降低严重TIAE发生率的关键驱动因素。我们推出了一个由四部分组成的气道安全综合方案，包括：（1）基于体重的颜色编码设备图表，（2）气道设备视觉示意图，（3）推荐的药物剂量，以及（4）一份适用于一家三级PED和5家社区卫星PUC/PED的安全检查表。进行了多个计划-执行-研究-行动循环，并使用统计过程控制图监测结果。当实现特殊原因变异时，重新制定图表。本研究旨在将三级医疗机构的严重TIAE发生率从基线的23%和社区医疗机构的25%在12个月内降至<15%，并将这些结果维持6个月。
在研究期间，我们注意到干预期间PED和PUC环境中严重TIAE的发生率均有所下降，并且我们在所有地点将这一改善维持了6个月以上，平衡措施没有相关变化。
在广泛的地理区域和不同培训水平的人员中实施气道安全综合方案是可行的，并且有可能在多个临床环境中降低严重TIAE。
