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
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
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DOI：
10.1097/ccm.0000000000004725
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发表时间：
2021-02-01
影响因子：
8.8
通讯作者：
Nadkarni, Vinay
中科院分区：
文献类型：
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作者：
Nishisaki, Akira;Lee, Anthony;Nadkarni, Vinay
目的：评估气管插管安全捆绑包对15个PICU中不良气管插管相关事件的影响。设计：多中心时间序列研究。设置：美国的PICU。患者：所有患者在ICU接受气管插管。干预：我们实施了气管插管安全捆绑包作为质量改进干预措施，包括：1）每季度现场基准性能报告和2）气道安全检查表（术前风险因素、方法和角色规划、术前床边“暂停”和术后立即汇报）。我们将每个质量改进阶段定义为基线（检查表实施前的-24到-12个月），仅基准性能报告（检查表实施前的-12到0个月），实施（检查表实施开始到时间实现> 80%的捆绑依从性），早期捆绑依从性（0-12个月）和持续（后期）捆绑依从性（12-24个月）。束坚持被定义为先验的80%以上的检查表使用气管插管连续3 months.MEASUREMENTS和主要结果：主要结果是不良气管插管相关事件，次要结果包括严重的气管插管相关事件，多次气管插管尝试，低氧血症小于80%。从2013年1月至2015年12月，在19个参与的PICU中，15个ICU（79%）实现了捆绑依从性。在15个ICU中，气管插管相关不良事件发生率为基线期：217/1，241（17.5%），仅基准报告阶段：257/1，750（14.7%），早期0-12个月完全捆绑合规阶段：247/1，591（15.5%），12-24个月后期完全捆绑合规期：137/1，002（13.7%）。在调整患者特征和按中心聚类后，与基线相比，气管插管相关不良事件发生率显著降低：基准：比值比，0.83（0.72-0.97; p = 0.016）;早期捆绑：比值比，0.80（0.63-1.02; p = 0.074）;晚期捆绑优势比，0.63（0.47-0.83; p = 0.001）。结论：有效实施质量改进包与不良气管插管的减少有关-相关事件持续了24个月。
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.