A Preprocedural Checklist Improves the Safety of Emergency Department Intubation of Trauma Patients

Abstract

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.

Improving neonatal intubation safety: A journey of a thousand miles

“…Using statistical process control methods, the improvements were temporally related to implementation of the "Intubation Timeout" tool [27]. The authors concluded that the improvements noted were due to improvements in team communication and function prior to, and during, the intubation encounter, a finding which has been reported in adult and pediatric intubations as well [28][29][30].…”

Emergency airway management in Australian and New Zealand emergency departments: A multicentre descriptive study of 3710 emergency intubations

“…12 Arguably, novices should not perform this procedure in EDs, with stronger consideration given to the acquisition of laryngoscopy and intubation skills in the controlled setting of the operating theatre or simulation environment. 19,20 Factors associated with improved first attempt success rate included video laryngoscopy, bougie use and a CL grade I or grade II view. The majority of patients were men, and most had a medical indication for intubation, similar to other studies.…”

“…Although a pre-intubation checklist did not favourably influence success or complication rates, we support its use due to the potential to reduce stress and error during this high-risk procedure. 19,20 Factors associated with improved first attempt success rate included video laryngoscopy, bougie use and a CL grade I or grade II view. This is consistent with previous studies.…”

Intubation Checklists: Expanding Beyond Single Centers

“…We applaud the recent study by Smith et al . highlighting the impact that preprocedure checklists can have on safety metrics of peri‐intubation care in trauma patients.…”