A Comprehensive Quality Improvement Program to Improve Intubation Performance in Critical Care Transport

Q3 Nursing
Andrew P. Reimer PhD, RN, CFRN, FAAN , Joshua Driscoll BSN, RN, CCRN , Lisa Lorenz MSN, ACNP, CCRN , Abigail Brown DNP, MBA, APRN, ACNP-C, CCRN, EMT-P , Travis Gullett MD, MATS, FACEP , Fredric M. Hustey MD
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引用次数: 0

Abstract

Objective

Advanced airway management is a primary skill critical care transport teams provide. There are several measures of performance for airway management that can be tracked and improved through quality improvement initiatives. The purpose of this project was to improve first-pass intubation success rates and the associated Definitive Airway Sans Hypoxia/Hypotension on First Attempt (DASH-1A) metric—definitive airway without hypoxia or hypotension.

Methods

A multiyear quality improvement initiative was undertaken. Best practices from the literature were identified and implemented through the Institute for Healthcare Improvement Model for Improvement using a plan-do-study-act cycle approach. Improvement cycles included airway training in a cadaver laboratory, implementation of an airway checklist, use of high-fidelity airway mannequins with simulation, and difficult airway mannequins that could be used for on-shift training. We prioritized tracking of first-pass intubation success rates with focused communication to the team.

Results

There was incremental improvement in first-pass success rates evidenced by the stepwise increase in annual moving averages starting at 59% and progressing to the current annual average at approximately 95%. Similarly, DASH-1A results exhibit similar incremental improvement in the moving annual average year on year, starting at 59% and improving to the current 92% annual average.

Conclusion

Our results demonstrate that a dedicated quality improvement project focused on improving airway management, specifically first-pass success and DASH-1A, improved our transport team's performance over time.
综合质量改进方案以提高危重监护运输中的插管性能
目的先进的气道管理是重症监护转运团队提供的一项主要技能。有几个衡量气道管理绩效的方法,可以通过质量改进计划进行跟踪和改进。该项目的目的是提高首次插管成功率和相关的首次尝试无缺氧/低血压的最终气道(DASH-1A) -无缺氧或低血压的最终气道。方法实施多年质量改进计划。通过医疗保健改进模型研究所使用计划-执行-研究-行动循环方法,确定并实施了文献中的最佳实践。改进周期包括在尸体实验室进行气道训练,气道检查表的实施,高保真气道模拟模型的使用,以及可用于轮班训练的高难度气道模拟模型。我们优先跟踪首次插管成功率,并与团队进行重点沟通。结果:首次通过成功率呈递增趋势,年移动平均值从59%开始逐步增加,到目前的年平均值约为95%。同样,DASH-1A的结果也显示出类似的年平均值逐年递增的改善,从59%开始,到目前的92%。我们的研究结果表明,一个专注于改善气道管理的质量改进项目,特别是首通成功和DASH-1A,随着时间的推移提高了我们运输团队的绩效。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Air Medical Journal
Air Medical Journal Nursing-Emergency Nursing
CiteScore
1.20
自引率
0.00%
发文量
112
审稿时长
69 days
期刊介绍: Air Medical Journal is the official journal of the five leading air medical transport associations in the United States. AMJ is the premier provider of information for the medical transport industry, addressing the unique concerns of medical transport physicians, nurses, pilots, paramedics, emergency medical technicians, communication specialists, and program administrators. The journal contains practical how-to articles, debates on controversial industry issues, legislative updates, case studies, and peer-reviewed original research articles covering all aspects of the medical transport profession.
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