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Pandian V, Ghazi TU, He MQ, Isak E, Saleem A, Semler LR, Capellari EC, Brenner MJ. Multidisciplinary Difficult Airway Team Characteristics, Airway Securement Success, and Clinical Outcomes: A Systematic Review. Ann Otol Rhinol Laryngol 2022:34894221123124. [DOI: 10.1177/00034894221123124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To investigate whether implementation of a multidisciplinary airway team was associated with improvement in (1) rate of successful airway securement at first attempt; (2) time to secure airway; and (3) overall complication rate in patients with a difficult airway, as compared with usual care. Data Sources: Ovid Medline, Embase, Scopus, Cochrane Central, and CINAHL databases. Review Methods: Systematic review of literature on inpatient multidisciplinary team management of difficult airways, including all studies performed in inpatient settings, excluding studies of ventilator weaning, flight/military medicine, EXIT procedures, and simulation or educational studies. DistillerSR was used for article screening and risk of a bias assessment to evaluate article quality. Data was extracted on study design, airway team composition, patient characteristics, and clinical outcomes including airway securement, complications, and mortality. Results: From 5323 studies screened, 19 studies met inclusion criteria with 4675 patients. Study designs included 12 quality improvement projects, 6 cohort studies, and 1 randomized controlled trial. Four studies evaluated effect of multidisciplinary difficult airway teams on airway securement; all reported higher first attempt success rate with team approach. Three studies reported time to secure the difficult airways, all reporting swifter airway securement with team approach. The most common difficult airway complications were hypoxia, esophageal intubation, hemodynamic instability, and aspiration. Team composition varied, including otolaryngologists, anesthesiologists, intensivists, nurses, and respiratory care practitioners. Conclusion: Multidisciplinary difficult airway teams are associated with improved clinical outcomes compared to unstructured emergency airway management; however, studies have significant heterogeneity in team composition, algorithms for airway securement, and outcomes reported. Further evidence is necessary to define the clinical efficacy, cost-effectiveness, and best practices relating to implementing difficult airway teams in inpatient settings.
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Affiliation(s)
- Vinciya Pandian
- Immersive Learning and Digital Innovations, Nursing Faculty, and Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA
| | - Talha U. Ghazi
- Michigan State University College of Human Medicine, West Bloomfield, MI, USA
| | - Marielle Qiaoshu He
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
- US Navy Medical Corps, Washington, DC, USA
| | - Ergest Isak
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Abdulmalik Saleem
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Lindsay R. Semler
- INTEGRIS Health, Oklahoma City, OK, USA
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Michael J. Brenner
- Department of Otolaryngology–Head & Neck Surgery, University of Michigan, Ann Arbor, MI, USA
- Global Tracheostomy Collaborative, Raleigh, NC, USA
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Rotter J, Carlstrom LP, Graffeo CS, Nesvick CL, Gunnels M, Hellickson JD, Marcellino C, Atkinson JLD. Streamlining the External Ventricular Drain and Intracranial Pressure Monitor Procedural Setup: A Quality Improvement Initiative. World Neurosurg 2022; 166:e475-e483. [PMID: 35843582 DOI: 10.1016/j.wneu.2022.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE External ventricular drain (EVD) and intracranial pressure (ICP) monitor placements are among the most common critical care procedures for severe brain injury. Quality improvement initiatives have streamlined similar processes. The aim of the project was to decrease the time to collect supplies for EVD or ICP monitor placement by 25% by April 1, 2021. METHODS The project followed the define-measure-analyze-improve-control 6 sigma framework. Several quality gaps were identified: equipment stored separately, delays in replacing faulty items, and wasted resources. The team defined the process using the suppliers-inputs-processes-outputs-customers + requirements method, measured time to collect supplies, and analyzed data with an Ishikawa/fishbone diagram. The improve phase included a kaizen burst to generate solutions and an impact/effort grid to evaluate options. The team concluded that the optimal plan was to stock a mobile EVD cart and an ICP monitor pole with disposable go-bags. RESULTS The average time for nurses to collect EVD placement supplies decreased from 411 to 63 seconds (7-1 minute), and the average time for nurses to collect ICP monitor placement supplies decreased from 418 to 53 seconds (7-<1 minute). Residents decreased the time to obtain EVD placement supplies from 330 to 56 seconds (6-<1 minute) and ICP monitor supplies from 489 to 77 seconds (8-1 minute). Feedback was overwhelmingly positive and focused on improved process efficiency and reduced waste. CONCLUSIONS The time reduction and enthusiasm are likely associated with the simplicity and comprehensiveness of the intervention design. Including key stakeholders in decision-making and succinct communications reduced resistance to change.
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Affiliation(s)
- Juliana Rotter
- Department of Neurologic Surgery, Mayo Clinic, Rochester Minnesota, USA.
| | - Lucas P Carlstrom
- Department of Neurologic Surgery, Mayo Clinic, Rochester Minnesota, USA
| | | | - Cody L Nesvick
- Department of Neurologic Surgery, Mayo Clinic, Rochester Minnesota, USA
| | - Marshall Gunnels
- Department of Neurologic Surgery, Mayo Clinic, Rochester Minnesota, USA
| | - Jodi D Hellickson
- Department of Neurologic Surgery, Mayo Clinic, Rochester Minnesota, USA
| | | | - John L D Atkinson
- Department of Neurologic Surgery, Mayo Clinic, Rochester Minnesota, USA
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Piechowski W, Clapper TC, Park JC, Ching K, St. George J. A prospective randomised simulation trial comparing our novel AIR-BOX to standard airway equipment storage modalities. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 7:311-318. [PMID: 35515731 PMCID: PMC8936580 DOI: 10.1136/bmjstel-2020-000721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/18/2020] [Accepted: 10/12/2020] [Indexed: 11/04/2022]
Abstract
Background There is little evidence guiding equipment handling during emergency endotracheal intubations (EEI). Available evidence and current practice are either outdated, anecdotal or focused on difficult-not emergency-intubation. In this study, we describe and evaluate our equipment handling unit: the AIR-BOX. Methods This is a proof-of-concept, prospective, randomised simulation trial. A convenience sample of 50 airway course participants voluntarily underwent randomisation: 21 to the AIR-BOX group, 14 to the intubation box group, and 15 to the crash cart group. The volunteers were asked to intubate a manikin using the equipment from the storage unit of their randomisation. Outcome measures included time-to-readiness, time-to-intubation, first-pass success, and subjective operator experience. Results The mean time-to-readiness was 67.2 s with the AIR-BOX, 84.6 s with the intubation box, and 115 s with the crash cart. The mean time-to-intubation was 105 s with the AIR-BOX, 127 s with the intubation box and 167 s with the crash cart. A statistically significant difference was achieved between the AIR-BOX and the crash cart. No statistically significant difference was found between the three groups with regard to first-pass success or the time between intubation readiness and intubation. Conclusions This study supports the AIR-BOX as a viable tool that can improve and simplify access to emergency intubating equipment. It also opens doors for multiple future innovations that can positively impact equipment handling practices. Future studies can focus on assessing whether applying the AIR-BOX will yield a clinically significant impact on patient outcomes.
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Affiliation(s)
- Wojciech Piechowski
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Timothy C Clapper
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Joel C Park
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Kevin Ching
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jonathan St. George
- Department of Emergency Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
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Coyle M, Martin D, McCutcheon K. Interprofessional simulation training in difficult airway management: a narrative review. ACTA ACUST UNITED AC 2020; 29:36-43. [DOI: 10.12968/bjon.2020.29.1.36] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The aim of this narrative literature review was to explore the impact of interprofessional simulation-based team training on difficult airway management. The Fourth National Audit Project of The Royal College of Anaesthetists and The Difficult Airway Society identified recurrent deficits in practice that included delayed recognition of critical events, inadequate provision of appropriately trained staff and poor collaboration and communication strategies between teams. Computerised databases were assessed to enable data collection, and a narrative literature review and synthesis of eight quantitative studies were performed. Four core themes were identified: debriefing, measures of assessment and evaluation, non-technical skills and patient safety, and patient outcomes. There are many benefits to be gained from interprofessional simulation training as a method of teaching high-risk and infrequent clinical airway emergencies. The practised response to emergency algorithms is crucial and plays a vital role in the reduction of errors and adverse patient outcomes.
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Affiliation(s)
- Maria Coyle
- Anaesthetic Nurse Specialist, Royal Victoria Hospital, Belfast
| | - Daphne Martin
- Lecturer, School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast
| | - Karen McCutcheon
- Senior Lecturer, School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast
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Long L, Vanderhoff B, Smyke N, Shaffer L, Solomon J, Steuer JD. Management of Difficult Airways Using a Hospital-Wide “Alpha Team” Approach. Am J Med Qual 2010; 25:297-304. [DOI: 10.1177/1062860610366587] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | - L.E.T. Shaffer
- OhioHealth Research and Innovation Institute, Columbus, OH
| | - Joseph Solomon
- OhioHealth Research and Innovation Institute, Columbus, OH
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