Wong Kei U, Gross Isabel, Emerson Beth L, Goldman Michael P
Emergency Medicine (Pediatric Emergency Medicine Division), Rutgers New Jersey Medical School, Newark, New Jersey, USA.
Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
BMJ Simul Technol Enhanc Learn. 2021 Jun 4;7(6):561-567. doi: 10.1136/bmjstel-2020-000810. eCollection 2021.
Emergent paediatric intubation is an infrequent but high-stakes procedure in the paediatric emergency department (PED). Successful intubations depend on efficient and accurate preparation. The aim of this study was to use airway drills (brief in-situ simulations) to identify gaps in our paediatric endotracheal intubation preparation process, to improve on our process and to demonstrate sustainability of these improvements over time in a new staff cohort.
This was a single-centre, simulation-based improvement study. Baseline simulated airway drills were used to identify barriers in our airway preparation process. Drills were scored for time and accuracy on an iteratively developed 16-item rubric. Interventions were identified and their impact was measured using simulated airway drills. Statistical analysis was performed using unpaired t-tests between the three data collection periods.
Twenty-five simulated airway drills identified gaps in our airway preparation process and served as our baseline performance. The main problem identified was that staff members had difficulty locating essential airway equipment. Therefore, we optimised and implemented a weight-based airway cart. We demonstrated significant improvement and sustainability in the accuracy of obtaining essential airway equipment from baseline to postintervention (62% vs 74%; p=0.014), and postintervention to sustainability periods (74% vs 77%; p=0.573). Similarly, we decreased and sustained the time (in seconds) required to prepare for a paediatric intubation from baseline to postintervention (173 vs 109; p=0.001) and postintervention to sustainability (109 vs 103; p=0.576).
Simulated airway drills can be used as a tool to identify process gaps, measure and improve paediatric intubation readiness.
在儿科急诊科（PED），紧急儿科插管是一种不常进行但风险很高的操作。成功的插管取决于高效且准确的准备工作。本研究的目的是通过气道演练（简短的现场模拟）来识别我们儿科气管插管准备过程中的差距，改进我们的流程，并在新员工群体中证明这些改进随时间的可持续性。
这是一项基于模拟的单中心改进研究。使用基线模拟气道演练来识别我们气道准备过程中的障碍。根据一个经过反复开发的16项评分标准对演练的时间和准确性进行评分。确定干预措施，并使用模拟气道演练来衡量其影响。在三个数据收集期之间使用非配对t检验进行统计分析。
25次模拟气道演练识别出了我们气道准备过程中的差距，并作为我们的基线表现。发现的主要问题是工作人员难以找到基本的气道设备。因此，我们优化并实施了一个基于体重的气道推车。我们证明了从基线到干预后（62%对74%；p=0.014）以及从干预后到可持续期（74%对77%；p=0.573），获取基本气道设备的准确性有显著提高且具有可持续性。同样，我们从基线到干预后（173秒对109秒；p=0.001）以及从干预后到可持续期（109秒对103秒；p=0.576），减少并维持了儿科插管准备所需的时间（以秒为单位）。
模拟气道演练可作为一种工具，用于识别流程差距、衡量并提高儿科插管准备情况。
