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

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.