Balloons are being used more frequently for control of ischemia in more patients who are elderly with lower mortality. An institutional bias toward preoperative use of the balloon pump appears to be associated with improved outcomes.
Introduction:
Our goal was to characterize further variability in how providers both define a difficult intubation and apply a difficult tracheal intubation alert.
Materiala and Methods:
We developed a survey describing 26 different intubation scenarios encompassing a range of clinical complexity and equipment. Scenarios included multiple factors hypothesized to impact a provider’s definition of a difficult intubation and the threshold for a difficult intubation alert. Provider responses were then assessed for variability and agreement.
The survey was distributed at 2 academic medical centers, 1 in Portland, ME (1 teaching hospital, 600 beds) and 1 in Philadelphia, PA (2 teaching hospitals, 1180 total beds). Electronic surveys were sent to anesthesia and emergency medicine providers (total N=617). Providers were asked to grade the difficulty of the scenario presented and whether they would activate the difficult intubation alert in the electronic health record. Responses were pooled and summarized as a frequency (%) and analyzed by provider type and institution.
Results:
Providers lacked agreement about scenarios that were very difficult or when an alert should be used. This variability was similar among provider types and institutions. Providers assessed scenarios as being more difficult and were more likely to apply an alert when videolaryngoscopy was not available.
Conclusions:
Substantial variability was demonstrated in providers’ definition of a difficult intubation and the threshold to activate a difficult intubation alert. This variability is consistent with related findings by other groups and represents a latent patient safety threat. The availability alone of videolaryngoscopy influences a provider’s definition of a difficult intubation, resulting in the grading of a scenario as less difficult. The associated risks may be mitigated by the delineation of specific criteria for difficult intubation designation and alert activation at the hospital or health system level.
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