Reducing the incidence of oxyhaemoglobin desaturation during rapid sequence intubation in a paediatric XXXX .

@entity1 @entity341 @entity1170 @entity7672
OBJECTIVES: @entity1170 ( @entity1170 ) is the standard for definitive airway management in emergency medicine. In a video-based study of @entity1170 in a paediatric @entity341 ( @entity341 ), we reported a high degree of process variation and frequent adverse effects, including @entity7672 desaturation (SpO2<90%). This report describes a multidisciplinary initiative to improve the performance and safety of @entity1170 in a paediatric @entity341 . METHODS: We conducted a local improvement initiative in a high-volume academic paediatric @entity341 . We simultaneously tested: (1) an @entity1170 checklist, (2) a pilot/copilot model for checklist execution, (3) the use of a video laryngoscope and (4) the restriction of laryngoscopy to specific providers. Data were collected primarily by video review during the testing period and the historical period (2009-2010, baseline). We generated statistical process control charts (G-charts) to measure change in the performance of six key processes, attempt failure and the occurrence of oxyhaemoglobin desaturation during @entity1170 . We iteratively revised the four interventions through multiple plan-do-study-act cycles within the Model for Improvement. RESULTS: There were 75 cases of @entity1170 during the testing period (July 2012-September 2013). Special cause variation occurred on the G-charts for three of six key processes, attempt failure and desaturation, indicating significant improvement. The frequency of desaturation was 50% lower in the testing period than the historical (16% vs 33%). When all six key processes were performed, only 6% of @entity1 experienced desaturation. CONCLUSIONS: Following the simultaneous introduction of four interventions in a paediatric @entity341 , @entity1170 was performed more reliably, successfully and safely.
