The University of Kansas Health System, Department of Emergency Medicine, Kansas City, Kansas.
The University of California San Francisco, Department of Emergency Medicine, San Francisco, California.
West J Emerg Med. 2021 Jul 14;22(4):827-833. doi: 10.5811/westjem.2021.4.51115.
Intubation and mechanical ventilation are common interventions performed in the emergency department (ED). These interventions cause pain and discomfort to patients and necessitate analgesia and sedation. Recent trends in the ED and intensive care unit focus on an analgesia-first model to improve patient outcomes. Initial data from our institution demonstrated an over-emphasis on sedation and an opportunity to improve analgesic administration. As a result of these findings, the ED undertook a quality improvement (QI) project aimed at improving analgesia administration and time to analgesia post-intubation.
We performed a pre-post study between January 2017-February 2019 in the ED. Patients over the age of 18 who were intubated using rapid sequence intubation (RSI) were included in the study. The primary outcome was the rate of analgesia administration; a secondary outcome was time to analgesia administration. Quality improvement interventions occurred in two phases: an initial intervention focused on nursing education only, and a subsequent intervention that included nursing and physician education.
During the study period, 460 patients were intubated in the ED and met inclusion/exclusion criteria. Prior to the first intervention, the average rate of analgesia administration was 57.3%; after the second intervention, the rate was 94.9% (P <0.01). Prior to the first intervention, average time to analgesia administration was 36.0 minutes; after the second intervention, the time was 16.6 minutes (P value <0.01).
This QI intervention demonstrates the ability of education interventions alone to increase the rate of analgesia administration and reduce the time to analgesia in post-intubation patients.
插管和机械通气是急诊科（ED）中常见的干预措施。这些干预措施会给患者带来疼痛和不适，需要进行镇痛和镇静。ED 和重症监护病房（ICU）的最新趋势侧重于采用镇痛优先的模式来改善患者的预后。我院的初步数据表明，镇静的重视程度过高，有机会改善镇痛药物的管理。基于这些发现，ED 开展了一项质量改进（QI）项目，旨在改善插管后患者的镇痛药物管理和镇痛起效时间。
我们在 2017 年 1 月至 2019 年 2 月期间在 ED 进行了一项前后对照研究。研究纳入了年龄大于 18 岁且使用快速序贯诱导插管（RSI）进行插管的患者。主要结局是镇痛药物管理的实施率；次要结局是镇痛起效时间。QI 干预分为两个阶段：第一阶段仅关注护理教育，第二阶段包括护理和医生教育。
在研究期间，460 名患者在 ED 中插管并符合纳入/排除标准。在第一阶段干预之前，镇痛药物管理的平均实施率为 57.3%；第二阶段干预后，该比例提高至 94.9%（P<0.01）。在第一阶段干预之前，平均的镇痛起效时间为 36.0 分钟；第二阶段干预后，该时间缩短至 16.6 分钟（P 值<0.01）。
这项 QI 干预表明，仅通过教育干预即可提高镇痛药物管理的实施率，并缩短插管后患者的镇痛起效时间。
