Improving first-pass success rates during emergency intubation at an academic emergency department: a quality improvement initiative

Author:

Bakhsh Abdullah1ORCID,Alharbi Ahd2,Almehmadi Raghad2,Kamfar Sara2,Aldhahri Arwa2,Aledeny Ahmed2,Ashour Yasmeen3,Khojah Imad1

Affiliation:

1. Department of Emergency Medicine, King Abdulaziz University Hospital, P.O. Box 80215, Jeddah 21589, Saudi Arabia

2. Faculty of Medicine, King Abdulaziz University Hospital, P.O. 80215, Jeddah 21589, Saudi Arabia

3. Department of Total Quality Management, King Abdulaziz University Hospital, Jeddah, Saudi Arabia

Abstract

Abstract Background Airway management is a high-stakes procedure in emergency medicine. Continuously monitoring this procedure allows performance improvement while revealing safety issues. We instituted a quality improvement initiative in the emergency department to improve first-pass success rates in the emergency department. Methods This was a quality improvement initiative at an academic emergency department from 2018 to 2020. We developed a rapid sequence intubation guideline for procedure standardization and introduced an intubation procedure note for performance monitoring. Data were entered directly by the primary physician and nurse during intubation. The quality improvement team thereafter collected the data retrospectively and entered into a local airway database. More importantly, we introduced a culture of quality improvement and safety in airway management via regular education and feedback. Results We included a total of 146 intubations. The first-pass success rate started at 57.1% and increased to 80.0% during the study period (P < 0.01). Fifty-six percent were male, and the mean age (±SD) was 55.56 (±17.64). Video laryngoscopy was used in 101 (69.2%) patients, while direct laryngoscopy was used in only 44 (30.8%) patients. A logistic regression analysis was conducted to determine the independent factors associated with first-pass success. These factors included the use of video laryngoscopy (odds ratio (OR) 2.47 95% confidence interval (95% CI) [1.62–3.76]) (adjusted OR 3.87 [1.13–13.23]) and good Cormack–Lehane views (grades 1–2) (OR 2.71 95% CI [1.74–4.20]) (adjusted OR 7.88 [2.43–25.53]). Conclusion Our study shows that implementing and maintaining an airway quality improvement program improves first-pass intubation success. Moreover, the use of video laryngoscopy and obtaining good Cormack–Lehane views (grades 1–2) are independently associated with improved first-pass success.

Publisher

Oxford University Press (OUP)

Subject

Public Health, Environmental and Occupational Health,Health Policy,General Medicine

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