Objectives
Endotracheal intubation of trauma patients is a vital and high‐risk procedure in the emergency department (ED). The hypothesis was that implementation of a standardized, preprocedural checklist would improve the safety of this procedure.
Methods
A preprocedural intubation checklist was developed and then implemented in a prospective pre‐/postinterventional study in an academic trauma center ED. The proportions of trauma patients older than 16 years who experienced intubation‐related complications during the 6 months before checklist implementation and 6 months after implementation were compared. Intubation‐related complications included oxygen desaturation, emesis, esophageal intubation, hypotension, and cardiac arrest. Additional outcomes included time from paralysis to intubation and adherence to safety process measures.
Results
During the study, 141 trauma patients were intubated, including 76 in the prechecklist period and 65 in the postchecklist period. A lower proportion of patients experienced intubation‐related complications in the postchecklist period (1.5%) than the prechecklist period (9.2%), representing a 7.7% (95% confidence interval = 0.5% to 14.8%) absolute risk reduction. Paralysis‐to‐intubation time was also lower in the postchecklist period (median = 82 seconds, interquartile range [IQR] = 68 to 101 seconds) compared to the prechecklist period (median = 94 seconds, IQR = 78 to 115 seconds; p = 0.02). Adherence to safety process measures also improved, with all safety measures performed in 69.2% in the postchecklist period compared to 17.1% before the checklist (p < 0.01).
Conclusions
Implementation of a preintubation checklist for ED intubation of trauma patients was associated with a reduction in intubation‐related complications, decreased paralysis‐to‐intubation time, and improved adherence to recognized safety measures.
Medical residency is an educational enterprise directed toward producing clinicians who recognize and correctly manage disease. While formal graduate medical education provides didactics and bedside teaching to improve knowledge, individual learning efforts are essential to the educational experience. Keeping track of patient outcomes after disposition from the emergency department (ED) is a useful exercise in reviewing gaps in knowledge of the individual and deficiencies in systems-based care. In reviewing the agreement between admission and discharge diagnoses of a single resident over 4 years of residency, significant improvement in diagnostic accuracy was observed. This method of self-correction has potential to supplement formal residency education in emergency medicine.ACADEMIC EMERGENCY MEDICINE 2011; 18:545-548 ª 2011 by the Society for Academic Emergency MedicineTo cover the vast field of medicine in four years is an impossible task. We can only instill principles, put the student in the right path, give him methods, teach him how to study, and early to discern between essentials and non-essentials. 1 R esidency is learning medicine while receiving guidance. Inevitably, there will be mistakes in judgment that result in incorrect diagnosis, treatment, or harm. Obtaining superior instruction in avoiding errors to emerge a competent physician is important in applicants' methods of residency selection; indeed the top considerations in a recent study were the reputation of the institution, the facilities, and the residency director.2 Fledgling interns want to feel that they have a dedicated institution behind them that will assist in their learning endeavors. But residency is not just about credentials and reputation: residents are attempting to develop habits that will reduce errors, promote patient care, and ultimately help them sleep easily after any given shift.Residency training has been shown to decrease the rate of malpractice claims in comparison with nonresidency-trained practitioners.
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