title: Development of a Quality Improvement Bundle to Reduce Tracheal Intubation-Associated Events in Pediatric ICUs.
abstract: Advanced airway management in the pediatric intensive care unit (PICU) is hazardous, with associated adverse outcomes. This report describes a methodology to develop a bundle to improve quality and safety of tracheal intubations. A prospective observational cohort study was performed with expert consensus opinion of 1715 children undergoing tracheal intubation at 15 PICUs. Baseline process and outcomes data in tracheal intubation were collected using the National Emergency Airway Registry for Children reporting system. Univariate analysis was performed to identify risk factors associated with adverse tracheal intubation-associated events. A multidisciplinary quality improvement committee was formed. Workflow analysis of tracheal intubation and pilot testing were performed to develop the Airway Bundle Checklist with 4 parts: (1) risk factor assessment, (2) plan generation, (3) preprocedure time-out to ensure that providers, equipment, and plans are prepared, (4) postprocedure huddle to identify improvement opportunities. The Airway Bundle Checklist developed may lead to improvement in airway management.
authors.affiliation: Maria Fareri Children's Hospital, New York Medical College, Valhalla, NY lis@wcmc.com.
authors.forename: Simon
authors.initials: S
authors.lastname: Li
authors.affiliation: Duke Children's Hospital, Durham, NC.
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Rehder
authors.affiliation: Yale University School of Medicine, New Haven, CT.
authors.forename: John S
authors.initials: JS
authors.lastname: Giuliano
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Michael
authors.initials: M
authors.lastname: Apkon
authors.affiliation: Emory University, Atlanta, GA.
authors.forename: Pradip
authors.initials: P
authors.lastname: Kamat
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Natalie
authors.initials: N
authors.lastname: Napolitano
authors.affiliation: Children's Hospital of Pittsburgh, Pittsburgh, PA.
authors.forename: Ann E
authors.initials: AE
authors.lastname: Thompson
authors.affiliation: Hasbro Children's Hospital, Providence, RI.
authors.forename: Craig
authors.initials: C
authors.lastname: Tucker
authors.affiliation: The Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Akira
authors.initials: A
authors.lastname: Nishisaki
mesh_terms: D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000458:organization & administration* / Q000592:standards; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D064872:Patient Care Bundles / Q000379:methods*; D061214:Patient Safety; D011446:Prospective Studies; D058996:Quality Improvement / Q000458:organization & administration*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
keywords: checklists; critical care; patient safety; pediatrics; quality improvement