title: The Royal North Shore Hospital Emergency Department airway registry: Closing the audit loop.
abstract: OBJECTIVE
  We aim to investigate whether a bundle of changes made to the practice of endotracheal intubation in our ED was associated with an improvement in first pass success rate and a reduction in the incidence of complications.
  
  
  METHODS
  We used a prospective observational study.
  
  
  RESULTS
  The data on 360 patients who were intubated during an 18-month period following the introduction of these changes were compared with our previously published observational data. Success on first attempt at intubation improved 83.4% to 93.9% (P < 0.0001). The proportion of patients with one or more complication fell from 29.0% to 19.4% (P < 0.042). Oesophageal intubation fell from 4.0% to 0.3% (P < 0.001), and there was a non-significant reduction in the rate of desaturation, from 15.6% to 10.9% (P < 0.07).
  
  
  CONCLUSIONS
  We have shown that, through the introduction of a bundle of changes that spans the domains of staff training, equipment and practice standardisation, we have made significant improvements in the safety of patients undergoing endotracheal intubation in our ED.
authors.affiliation: Emergency Department, Royal North Shore Hospital, Sydney, New South Wales, Australia.|CareFlight, Sydney, New South Wales, Australia.|Discipline of Emergency Medicine, Sydney University Medical School, Sydney, New South Wales, Australia.
authors.forename: Toby
authors.initials: T
authors.lastname: Fogg
authors.affiliation: Emergency Care Institute, Agency for Clinical Innovation, Sydney, New South Wales, Australia.
authors.forename: Hatem
authors.initials: H
authors.lastname: Alkhouri
authors.affiliation: Emergency Department, Royal North Shore Hospital, Sydney, New South Wales, Australia.|Discipline of Emergency Medicine, Sydney University Medical School, Sydney, New South Wales, Australia.|Sydney Clinical Skills and Simulation Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Vassiliadis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D064872:Patient Care Bundles / Q000379:methods; D011446:Prospective Studies; D058996:Quality Improvement; D055815:Young Adult
keywords: airway management; complications; emergency medicine; intubation; quality improvement