title: Improving Pediatric Emergency Care by Implementing an Eligible Learner Endotracheal Intubation Policy.
abstract: OBJECTIVE
  Although endotracheal intubations (ETIs) are high-risk, low-frequency events, there are no nationally accepted training pathways or measures to ensure ETI competence for emergency department (ED) providers. Our objective was to determine whether implementation of an eligible learner ETI policy (ELETIP) led to improved first ETI attempt success rates and decreased immediate airway-related complications.
  
  
  METHODS
  This was a retrospective cross-sectional before-and-after study of outcomes after ELETIP implementation. The primary outcome was proportion of successful first ETI attempts; secondary outcomes were number of intubation attempts, time to intubation, need to call anesthesia for intubation, and airway-related complications.
  
  
  RESULTS
  Three hundred ninety patients were included (median age, 1.3 y; range, 1 day-24.7 y): 219 (56%) and 171 (44%) in the pre- and post-ELETIP periods, respectively. First successful ETI attempts increased from 65.1% to 75.7% (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.07-2.62). Secondary outcomes included mean number of intubation attempts (1.6-1.4, P = 0.01), time to intubation (5.6-4.9 minutes, P = 0.07), anesthesia intubations in the ED (5.9%-2.9%; OR, 0.48; 95% CI, 0.17-1.37), and intubation-related complications (32%-25.7%; OR, 0.74; 95% CI, 0.47-1.15).
  
  
  CONCLUSIONS
  An ELETIP is effective in improving ED care by increasing first ETI attempt success rates while decreasing overall intubation attempts. Physicians and physician learners with anesthesia training for critical airway management training have high ETI attempt success rates. Airway management training is essential to physician education and airway management skills for improving outcomes.
authors.affiliation: From the Sections of *Emergency Medicine and †Infectious Diseases, Department of Pediatrics, Baylor College of Medicine; and ‡Center for Clinical Effectiveness and Evidence Based Outcomes Center, Baylor College of Medicine/Texas Children's Hospital, Houston, TX.
authors.forename: Stephanie K
authors.initials: SK
authors.lastname: Leung
authors.forename: Andrea T
authors.initials: AT
authors.lastname: Cruz
authors.forename: Charles G
authors.initials: CG
authors.lastname: Macias
authors.forename: Paul E
authors.initials: PE
authors.lastname: Sirbaugh
authors.forename: Binita
authors.initials: B
authors.lastname: Patel
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards*; D004636:Emergency Service, Hospital; D004638:Emergency Treatment; D005260:Female; D006282:Health Personnel / Q000193:education*; D006291:Health Policy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000379:methods / Q000592:standards*; D008297:Male; D000070316:Pediatric Emergency Medicine / Q000592:standards*; D058996:Quality Improvement; D012189:Retrospective Studies; D055815:Young Adult