Norwegian Air Ambulance Foundation, Research and Development Department, Oslo, Norway; Lausanne University Hospital, Emergency Department, Lausanne, Switzerland; University of Stavanger, Faculty of Health Sciences, Department of Quality and Health Technology, Stavanger, Norway; Rega - Swiss Air Ambulance, Zürich, Switzerland.
Norwegian Air Ambulance Foundation, Research and Development Department, Oslo, Norway; St. Olav University Hospital, Department of Emergency Medicine and Pre-Hospital Services, Trondheim, Norway; Norwegian University of Science and Technology, Institute of Circulation and Medical Imaging, Trondheim, Norway.
Br J Anaesth. 2022 Feb;128(2):e143-e150. doi: 10.1016/j.bja.2021.08.031. Epub 2021 Oct 19.
Pre-hospital advanced airway management is a complex intervention composed of numerous steps, interactions, and variables that can be delivered to a high standard in the pre-hospital setting. Standard research methods have struggled to evaluate this complex intervention because of considerable heterogeneity in patients, providers, and techniques. In this study, we aimed to develop a set of quality indicators to evaluate pre-hospital advanced airway management.
We used a modified nominal group technique consensus process comprising three email rounds and a consensus meeting among a group of 16 international experts. The final set of quality indicators was assessed for usability according to the National Quality Forum Measure Evaluation Criteria.
Seventy-seven possible quality indicators were identified through a narrative literature review with a further 49 proposed by panel experts. A final set of 17 final quality indicators composed of three structure-, nine process-, and five outcome-related indicators, was identified through the consensus process. The quality indicators cover all steps of pre-hospital advanced airway management from preoxygenation and use of rapid sequence induction to the ventilatory state of the patient at hospital delivery, prior intubation experience of provider, success rates and complications.
We identified a set of quality indicators for pre-hospital advanced airway management that represent a practical tool to measure, report, analyse, and monitor quality and performance of this complex intervention.
院前高级气道管理是一项复杂的干预措施，由许多步骤、相互作用和变量组成，可以在院前环境中达到高标准。由于患者、提供者和技术的高度异质性，标准的研究方法难以评估这种复杂的干预措施。在这项研究中，我们旨在制定一套质量指标来评估院前高级气道管理。
我们使用了一种改良的名义小组技术共识过程，包括三轮电子邮件和 16 名国际专家的共识会议。根据国家质量论坛衡量标准评估准则，对最终的质量指标集进行了可用性评估。
通过叙事文献综述确定了 77 个可能的质量指标，专家组又提出了 49 个指标。通过共识过程确定了最终的 17 个质量指标，包括三个结构指标、九个过程指标和五个结果相关指标。质量指标涵盖了院前高级气道管理的所有步骤，从预充氧和使用快速序列诱导到患者在医院分娩时的通气状态、提供者之前的插管经验、成功率和并发症。
我们确定了一套院前高级气道管理的质量指标，这是衡量、报告、分析和监测这一复杂干预措施的质量和绩效的实用工具。
