Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India.
College of Nursing, All India Institute of Medical Sciences, New Delhi, India.
BMJ Open Qual. 2021 Jul;10(Suppl 1). doi: 10.1136/bmjoq-2021-001448.
Airway management is a life-saving procedure in the emergency department (ED). Hypoxia during rapid sequence intubation (RSI) is associated with high morbidity and mortality.
To decrease the median time of intubation (time from administration of paralytic agent to the successful passage of endotracheal tube) by 40% from baseline 300 s in patients undergoing RSI in the ED.
A multidisciplinary quality improvement team worked to improve the airway management. The bottle necks identified using process mapping and fish bone analysis were lack of formal training of residents and nursing officers, and communication gap between residents and nursing officers. Change ideas focused on training residents in laryngoscopy and intubation and nursing officers in facilitating airway management by preparation of drugs and equipment; on-site awareness of logistical issues to the residents and nursing officers, introducing airway drug checklist and ensuring availability of difficult airway equipment.
After implementation of change ideas there was a significant reduction in intubation time. At the end of first Plan-Do-Study-Act (PDSA) cycle median intubation time was 165 s (IQR 125 s). By the end of last PDSA cycle, median intubation time reduced to 157 s (IQR 66 s). A shift was obtained on the run chart with a new median time of 141.5 s from mid-PDSA 1. The 8-week data after the end of PDSA 3 showed sustainability with median time of 126 s (IQR 42 s).
A well organised team effort, simple change ideas such as structured training of residents and nursing officers, introduction of airway drug checklist and improved communication can decrease the intubation time in a chaotic ED.
气道管理是急诊科（ED）的一项救生程序。在快速序贯插管（RSI）过程中缺氧与高发病率和死亡率相关。
将 ED 中接受 RSI 的患者的插管中位时间（从给予肌松剂到成功插入气管内管的时间）从基线的 300 秒减少 40%。
一个多学科质量改进团队致力于改善气道管理。通过流程映射和鱼骨分析确定的瓶颈是住院医师和护理人员缺乏正规培训，以及住院医师和护理人员之间的沟通差距。改变思路的重点是培训住院医师进行喉镜检查和插管，以及培训护理人员通过准备药物和设备来协助气道管理；向住院医师和护理人员现场了解后勤问题，引入气道药物检查表，并确保困难气道设备的可用性。
在实施变更思路后，插管时间显著缩短。在第一个计划-执行-研究-行动（PDSA）周期结束时，中位插管时间为 165 秒（IQR 125 秒）。在最后一个 PDSA 周期结束时，中位插管时间减少到 157 秒（IQR 66 秒）。在运行图上获得了一个新的转变，从中期 PDSA1 开始的新中位时间为 141.5 秒。在 PDSA3 结束后的 8 周数据显示具有可持续性，中位时间为 126 秒（IQR 42 秒）。
一个组织良好的团队努力，简单的变更思路，如对住院医师和护理人员进行结构化培训、引入气道药物检查表和改善沟通，可以减少混乱的 ED 中的插管时间。
