title: Impact of checklists on peri-intubation care in ED trauma patients.
abstract: BACKGROUND
  Checklists have successfully been used in intensive care units (ICUs) to improve metrics of critical care. Proper peri-intubation care including use of appropriate induction agents and postintubation sedation is crucial when performing endotracheal intubation (ETI) on critically ill patients, especially in the emergency department (ED). We sought to evaluate the impact of checklists on peri-intubation care in ED trauma patients.
  
  
  METHODS
  We performed a retrospective review of all trauma patients intubated in the ED of an urban, level 1 academic center from November 2010 to October 2012. As part of a quality improvement project, a peri-intubation checklist was instituted on November 1, 2011 to guide peri-intubation care. Using a predesign and postdesign, we compared peri-intubation parameters using parametric and nonparametric statistics when appropriate to evaluate the impact of a checklist on peri-intubation care. We also evaluated outcome measures including mortality and lengths of stay.
  
  
  RESULTS
  During the 2-year study period, 187 trauma patients underwent ETI in the ED, 90 prechecklist and 97 postchecklist. Rapid sequence intubation (RSI) use was greater with the checklist than without (90.7% vs 75.6%, P=.005). No difference was found between the number of ETI attempts per patient, hemodynamic parameters (heart rate, blood pressure, and oxygen saturation), postintubation anxiolysis, median number of ventilator days, length of ED stay, length of ICU stay, or mortality.
  
  
  CONCLUSIONS
  Peri-intubation checklists result in higher rates of RSI in ED trauma patients but do not alter other measured metrics of peri-intubation care.
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Conroy
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Weingart
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Emergency Medicine, Saint Vincent Hospital, Erie, PA. Electronic address: jcarlson@svhs.org.
authors.forename: Jestin N
authors.initials: JN
authors.lastname: Carlson
mesh_terms: D000328:Adult; D057189:Checklist; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods / Q000401:mortality / Q000592:standards*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000628:therapy*