Jonathan L Kwong, Scott Bourn, Morgan Hillier, Mike Merko, A J Grass, Tim Ednie, P Richard Verbeek
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Prehospital electronic patient care records (ePCRs) were reviewed weekly to determine the proportion of intubated patients who had ETT placement confirmed in the ED at transfer of care. Interventions-Pre- and post-project paramedic focus groups were conducted to identify potential drivers, change ideas, and project feedback. Three staggered interventions were introduced over five months: (1) memorandums to paramedics, ED chiefs and respiratory therapy leads, (2) individualized paramedic feedback e-mails, and (3) ePCR changes and closing rules.</p><p><strong>Results: </strong>The pre-project focus group identified several potential drivers, such as physical barriers, interprofessional relationships, and communication. ETT confirmation remained ≥90% for the last eight weeks and interventions resulted in special cause variation. Median cases without verbal confirmation between paramedics and ED staff reduced from 5/week (IQR 2.5, 6.5) to 1/week (IQR 0, 2). UE was identified in 0.6% (2/340) of patients with ETT confirmation. The post-project focus group noted improvements in perceived accountability, interprofessional relationships, and satisfaction with interventions.</p><p><strong>Conclusion: </strong>Through a series of interventions, we improved the rate of ETT confirmation during ED transfer of care. Although rates of UE were low, improvement in ETT confirmation may lead to faster recognition of UE when it does occur thereby mitigating complications. The observed improvement was sustained after interventions ended.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.1000,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A Quality Improvement Initiative to Increase Confirmation of Prehospital Endotracheal Tube Placement at Emergency Department Transfer of Care.\",\"authors\":\"Jonathan L Kwong, Scott Bourn, Morgan Hillier, Mike Merko, A J Grass, Tim Ednie, P Richard Verbeek\",\"doi\":\"10.1080/10903127.2024.2366401\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>Rates of prehospital unplanned extubation (UE) range from 0 to 25% and are the result of many factors, including patient movement. Transfer of care of intubated patients to the emergency department (ED) involves significant patient movement and represents a high-risk event for UE. Frequent confirmation of endotracheal tube (ETT) placement is imperative for early recognition of UE and to minimize patient harm.</p><p><strong>Methods: </strong>Local Practice-Our baseline rate of verbal ETT position confirmation with a member of the ED team during ED transfer of care was 74%. Our goal was to increase this practice to >90% in six months. This project was completed in partnership with Toronto Paramedic Services. Prehospital electronic patient care records (ePCRs) were reviewed weekly to determine the proportion of intubated patients who had ETT placement confirmed in the ED at transfer of care. Interventions-Pre- and post-project paramedic focus groups were conducted to identify potential drivers, change ideas, and project feedback. Three staggered interventions were introduced over five months: (1) memorandums to paramedics, ED chiefs and respiratory therapy leads, (2) individualized paramedic feedback e-mails, and (3) ePCR changes and closing rules.</p><p><strong>Results: </strong>The pre-project focus group identified several potential drivers, such as physical barriers, interprofessional relationships, and communication. ETT confirmation remained ≥90% for the last eight weeks and interventions resulted in special cause variation. Median cases without verbal confirmation between paramedics and ED staff reduced from 5/week (IQR 2.5, 6.5) to 1/week (IQR 0, 2). UE was identified in 0.6% (2/340) of patients with ETT confirmation. The post-project focus group noted improvements in perceived accountability, interprofessional relationships, and satisfaction with interventions.</p><p><strong>Conclusion: </strong>Through a series of interventions, we improved the rate of ETT confirmation during ED transfer of care. Although rates of UE were low, improvement in ETT confirmation may lead to faster recognition of UE when it does occur thereby mitigating complications. 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引用次数: 0
摘要
目的:院前意外拔管率(UE)介于 0-25% 之间,是包括患者移动在内的多种因素共同作用的结果。将插管患者转移到急诊科(ED)需要大量的患者移动,是发生意外拔管的高风险事件。经常确认气管插管(ETT)的位置对于及早识别 UE 和最大限度地减少对患者的伤害至关重要。我们的目标是在六个月内将这一比例提高到 90%以上。该项目是与多伦多辅助医疗服务机构合作完成的。我们每周对院前电子患者护理记录(ePCR)进行审查,以确定在转院时在急诊室确认 ETT 置入的插管患者比例。干预措施 - 开展项目前和项目后的辅助医务人员焦点小组活动,以确定潜在的驱动因素、变革想法和项目反馈。在五个月的时间里,采取了三种交错式干预措施:结果:项目前焦点小组确定了几个潜在的驱动因素,如物理障碍、专业间关系和沟通。在过去八周内,ETT 确认率一直保持在 90% 以上,干预措施导致了特殊原因的变化。护理人员和急诊室工作人员之间未口头确认的病例中位数从每周 5 例(IQR 2.5,6.5)降至每周 1 例(IQR 0,2)。在得到 ETT 确认的患者中,0.6%(2/340)的患者被确认为 UE。项目结束后的焦点小组指出,在责任感、专业间关系和对干预措施的满意度方面都有所改善。结论:通过一系列干预措施,我们提高了急诊室转院护理期间的 ETT 确认率。虽然 UE 发生率较低,但 ETT 确认率的提高可在发生 UE 时更快地识别 UE,从而减少并发症。干预结束后,观察到的改善仍在持续。
A Quality Improvement Initiative to Increase Confirmation of Prehospital Endotracheal Tube Placement at Emergency Department Transfer of Care.
Objectives: Rates of prehospital unplanned extubation (UE) range from 0 to 25% and are the result of many factors, including patient movement. Transfer of care of intubated patients to the emergency department (ED) involves significant patient movement and represents a high-risk event for UE. Frequent confirmation of endotracheal tube (ETT) placement is imperative for early recognition of UE and to minimize patient harm.
Methods: Local Practice-Our baseline rate of verbal ETT position confirmation with a member of the ED team during ED transfer of care was 74%. Our goal was to increase this practice to >90% in six months. This project was completed in partnership with Toronto Paramedic Services. Prehospital electronic patient care records (ePCRs) were reviewed weekly to determine the proportion of intubated patients who had ETT placement confirmed in the ED at transfer of care. Interventions-Pre- and post-project paramedic focus groups were conducted to identify potential drivers, change ideas, and project feedback. Three staggered interventions were introduced over five months: (1) memorandums to paramedics, ED chiefs and respiratory therapy leads, (2) individualized paramedic feedback e-mails, and (3) ePCR changes and closing rules.
Results: The pre-project focus group identified several potential drivers, such as physical barriers, interprofessional relationships, and communication. ETT confirmation remained ≥90% for the last eight weeks and interventions resulted in special cause variation. Median cases without verbal confirmation between paramedics and ED staff reduced from 5/week (IQR 2.5, 6.5) to 1/week (IQR 0, 2). UE was identified in 0.6% (2/340) of patients with ETT confirmation. The post-project focus group noted improvements in perceived accountability, interprofessional relationships, and satisfaction with interventions.
Conclusion: Through a series of interventions, we improved the rate of ETT confirmation during ED transfer of care. Although rates of UE were low, improvement in ETT confirmation may lead to faster recognition of UE when it does occur thereby mitigating complications. The observed improvement was sustained after interventions ended.
期刊介绍:
Prehospital Emergency Care publishes peer-reviewed information relevant to the practice, educational advancement, and investigation of prehospital emergency care, including the following types of articles: Special Contributions - Original Articles - Education and Practice - Preliminary Reports - Case Conferences - Position Papers - Collective Reviews - Editorials - Letters to the Editor - Media Reviews.