Sustained Improvement in Tracheal Intubation Safety Across a 15-Center Quality-Improvement Collaborative: An Interventional Study From the National Emergency Airway Registry for Children Investigators

Akira Nishisaki, Anthony Lee, Simon Li, Ronald C. Sanders, Calvin A. Brown, Kyle J. Rehder, Natalie Napolitano, Vicki L. Montgomery, Michelle Adu-Darko, G. Kris Bysani, Ilana Harwayne-Gidansky, Joy D. Howell, Sholeen Nett, Alberto Orioles, Matthew Pinto, Asha Shenoi, David Tellez, Serena P. Kelly, Melinda Register, Keiko TarquinioDennis Simon, Conrad Krawiec, Justine Shults, Vinay Nadkarni

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

Objectives: To evaluate the effect of a tracheal intubation safety bundle on adverse tracheal intubation-associated events across 15 PICUs. Design: Multicenter time-series study. Setting: PICUs in the United States. Patients: All patients received tracheal intubations in ICUs. Interventions: We implemented a tracheal intubation safety bundle as a quality-improvement intervention that includes: 1) quarterly site benchmark performance report and 2) airway safety checklists (preprocedure risk factor, approach, and role planning, preprocedure bedside "time-out," and immediate postprocedure debriefing). We define each quality-improvement phase as baseline (-24 to -12 mo before checklist implementation), benchmark performance reporting only (-12 to 0 mo before checklist implementation), implementation (checklist implementation start to time achieving > 80% bundle adherence), early bundle adherence (0-12 mo), and sustained (late) bundle adherence (12-24 mo). Bundle adherence was defined a priori as greater than 80% of checklist use for tracheal intubations for 3 consecutive months. Measurements and Main Results: The primary outcome was the adverse tracheal intubation-associated event, and secondary outcomes included severe tracheal intubation-associated events, multiple tracheal intubation attempts, and hypoxemia less than 80%. From January 2013 to December 2015, out of 19 participating PICUs, 15 ICUs (79%) achieved bundle adherence. Among the 15 ICUs, the adverse tracheal intubation-associated event rates were baseline phase: 217/1,241 (17.5%), benchmark reporting only phase: 257/1,750 (14.7%), early 0-12 month complete bundle compliance phase: 247/1,591 (15.5%), and late 12-24 month complete bundle compliance phase: 137/1,002 (13.7%). After adjusting for patient characteristics and clustering by site, the adverse tracheal intubation-associated event rate significantly decreased compared with baseline: benchmark: odds ratio, 0.83 (0.72-0.97; p = 0.016); early bundle: odds ratio, 0.80 (0.63-1.02; p = 0.074); and late bundle odds ratio, 0.63 (0.47-0.83; p = 0.001). Conclusions: Effective implementation of a quality-improvement bundle was associated with a decrease in the adverse tracheal intubation-associated event that was sustained for 24 months.

Original languageEnglish (US)
Pages (from-to)250-260
Number of pages11
JournalCritical care medicine
Volume49
Issue number2
DOIs
StatePublished - Feb 1 2021

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

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