Butler Ava, Chen Michael, Kaushik Shruti, Lee Terra, Raudaschl Liam, Giles Audrey
Faculty of Emergency Medicine, University of British Columbia, Duncan, BC, Canada.
Medical Biochemistry (Island Health), UBC, University of Victoria, Victoria, BC, Canada.
CJEM. 2025 Mar;27(3):207-214. doi: 10.1007/s43678-024-00828-8. Epub 2025 Jan 4.
Management of the adult airway is one of the most stressful and time-critical procedures in emergency medicine. In the Cowichan District Hospital, a rural hospital in British Columbia, Emergency Department (ED) staff were uncomfortable with acquiring the equipment needed for adult advanced airway management and the mean length of time to acquire the equipment was 319 s. The aim of this quality improvement (QI) project was to decrease the time to obtain the equipment needed for adult advanced airway management by nurses and physicians in the Cowichan District Hospital ED to less than 90 s by May 2023.
The Institute for Healthcare Improvement model of improvement was used to reduce the amount of time required to obtain the equipment for adult difficult airway management in the ED, which was measured using a standardised tabletop simulation every 2 weeks. Change ideas included using a colour-coded airway cart and employing translational simulation. Qualitative interviews with emergency department staff after intubations of patients in the ED captured process measures by examining provider comfort.
From December 2022 to May 2023, the mean time to obtain equipment for adult advanced airway management decreased from an initial value of 319 s to 76 s, a 76% improvement from the baseline. Qualitative interviews obtained pre-intervention, mid-intervention and post-intervention reflected themes of initial discomfort, shifting discomfort to comfort and finally to comfort.
The change ideas of using a colour-coded airway cart and translational simulation were associated with a reduction in time to obtain equipment for management of the adult advanced airway as well as improved provider comfort with the procedure in a rural ED.
成人气道管理是急诊医学中压力最大且时间要求最紧迫的操作之一。在不列颠哥伦比亚省的一家乡村医院考伊琴区医院，急诊科工作人员对获取成人高级气道管理所需设备感到不自在，获取设备的平均时间为319秒。这个质量改进（QI）项目的目标是到2023年5月，将考伊琴区医院急诊科护士和医生获取成人高级气道管理所需设备的时间减少到90秒以内。
采用医疗保健改进研究所的改进模型来减少急诊科获取成人困难气道管理设备所需的时间，每两周使用标准化桌面模拟进行测量。改进想法包括使用颜色编码的气道推车和采用转化模拟。在急诊科对患者进行插管后，对急诊科工作人员进行定性访谈，通过检查提供者的舒适度来获取过程指标。
从2022年12月到2023年5月，获取成人高级气道管理设备的平均时间从初始值319秒降至76秒，较基线提高了76%。定性访谈获取的干预前、干预中和干预后情况反映出从最初的不自在，到不自在向自在转变，最终达到自在的主题。
使用颜色编码的气道推车和转化模拟的改进想法与减少获取成人高级气道管理设备的时间相关，同时提高了乡村急诊科工作人员对该操作的舒适度。
