Improving the safety and quality of tracheal intubation in pediatric ICUs

提高儿科 ICU 气管插管的安全性和质量

• 批准号: 8607627
• 负责人: AKIRA NISHISAKI
• 金额: $ 24.96万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-30 至 2015-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8607627
• 关键词: Improving; safety; quality; tracheal; intubation

Project summary Tracheal intubation (TI) is a common life-saving procedure for critically ill children, but associated with frequent complications and adverse safety outcomes. Currently, no single quality improvement (QI) intervention has proven effective to improve TI safety and reduce complications. With prior AHRQ R03 and Pediatric Acute Lung Injury and Sepsis Investigator (PALISI) network support, we have already conducted a risk assessment using our robust multi-center pediatric TI safety registry: National Emergency Airway Registry for Children (NEAR-4-KIDS), with clear operational definitions and >95% compliance to capture key patient, provider and practice factors associated with preventable adverse events and TI failure. We have already assembled QI and content experts to develop a bundle of evidence-based safety interventions and a consensus implementation plan. The elements of the toolkit specifically include 1) TI planning with a risk factor review checklist, 2) a bedside "time-out" immediately before TI to review crew resource management/team roles, 3) a bedside "time-out" immediately after TI to reflect and debrief, and 4) quantitative debriefing among participating centers to share best practices on implementation of the safe practice intervention. This project will rigorously evaluate the clinical impact of our collaboratively developed NEAR4KIDS TI safe practice bundled intervention across a diverse spectrum of (large and small, academic and private) pediatric ICUs. Further, this project will identify and mitigate the safe bundled intervention uptake, adoption, implementation processes and variances at the individual site level. This approach includes standardized outcome measures using our NEAR4KIDS registry, measures of bundle adherence, safety culture, focus groups, and semi-structured interviews. We will employ mixed-method quantitative and qualitative analyses to identify the key factors and barriers for the safe practice bundled QI intervention adoption in diverse pediatric hospital settings. Based on these analyses, we will further refine the safe practice "toolkit" and implementation approach. The anticipated clinical impact of safe practice bundled intervention implementation will be measured prospectively by our NEAR4KIDS registry process of care measures, and most importantly by a meaningful absolute risk reduction in adverse TI associated events. We have access to large implementation networks including PALISI and the American Heart Association life support training programs poised to disseminate the toolkit beyond these 16 centers, at the completion of the 2 year AHRQ R18 project. Upon successful completion, we will have developed and refined a safe practice bundled intervention toolkit and evidence-based implementation and dissemination plan to improve the safe delivery of care across diverse hospital settings.

项目摘要 气管插管（TI）是一种常见的重症儿童救生程序，但与 频繁的并发症和不良的安全性结果。目前，没有单一的质量改进（QI） 已证明干预可有效提高TI安全性并减少并发症。与之前的AHRQ R03和 儿科急性肺损伤和脓毒症研究者（PALISI）网络支持，我们已经进行了一项 使用我们强大的多中心儿科TI安全登记系统进行风险评估：国家紧急气道 儿童登记处（NEAR-4-KIDS），具有明确的操作定义和> 95%的合规性 与可预防的不良事件和TI失败相关的关键患者、提供者和实践因素。我们有 已经召集了QI和内容专家，以制定一系列基于证据的安全干预措施， 协商一致的执行计划。工具包的要素具体包括：1）具有风险的TI规划 因素审查清单，2）在TI之前立即进行床边"暂停"，以审查机组人员资源 管理/团队角色，3）TI后立即进行床边"暂停"，以进行反思和汇报，以及4） 在参与中心之间进行定量汇报，以分享实施安全管理局的最佳做法 练习干预。 该项目将严格评估我们合作开发的NEAR4KIDS TI安全的临床影响 在不同的儿科（大型和小型，学术和私人）实践捆绑干预 重症监护室此外，该项目将确定和减轻安全的捆绑干预措施的吸收，采用， 实施过程和差异在个别网站的水平。这种方法包括标准化 使用我们的NEAR4KIDS注册表的结果测量，捆绑依从性的测量，安全文化，焦点小组， 半结构化面试我们将采用定量和定性分析相结合的方法， 确定在不同儿科中采用安全实践捆绑式QI干预的关键因素和障碍 医院设置。在这些分析的基础上，我们将进一步完善安全实践"工具包"和实施 approach.安全实践捆绑干预实施的预期临床影响将是 通过我们的NEAR4KIDS注册护理措施流程进行前瞻性测量，最重要的是通过 不良TI相关事件的绝对风险显著降低。我们有机会获得大型实施 包括PALISI和美国心脏协会生命支持培训计划在内的网络， 在为期两年的AHRQ R18项目完成后，将工具包传播到这16个中心之外。 成功完成后，我们将开发和完善一个安全做法捆绑干预工具包 以证据为基础的实施和传播计划，以改善在不同地区安全提供护理， 医院设置。