(415) Airway Response Team: Preventing Clinical Deterioration Outside of the ICU

Introduction: Historically, patients requiring definitive airway management before transfer to intensive care necessitated activation of the medical emergency team. Approximately 30% of medical emergencies were related to airway only emergencies. Additionally, from January 2019 to October 2019, 8.7% of the airway emergencies outside the intensive care units deteriorated to medical emergencies. Literature has shown peri-intubation cardiac arrest rates between 2.7-23% and standardizing approaches for critically ill patients improves their outcomes (De Jong et al., 2018; Marin et al, 2019; Russotto et al, 2021).

Methods: The airway response team (ART) was created to enhance hemodynamic optimization and post intubation management. ART started in 2019 composed of the rapid response team, anesthesia, respiratory therapists, pharmacist and an intensive care nurse. A benchmark goal of 3% or less of airways progressing to medical emergencies was set with a weekly quality review.

Results: During the initial role out of the ART from October 2019 to February 2020, outcomes improved with only 0.76% of airway emergencies deteriorating to medical emergencies. COVID impacted the organization during March 2020 and the ART expanded to perform all intubations outside of the emergency department and procedural areas. During this time, the team had 351 ART calls and performed 300 intubations with 0.67% deteriorating to medical emergencies. The team progressed back to its original design at the end of 2020. For 2021, 1 out of 127 (0.79%) and in 2022, 3 out of 126 (2.38%) ARTs progressed to a medical emergency. In 2023, 0 out of 126 (0%) of the ARTs progressed to a medical emergency.

ART members completed two anonymous surveys to assess team dynamics. The first was completed in May 2022 revealing opportunities in interdisciplinary communication. Interventions included redefining roles, adding a time out and promoting debriefs. A second survey was completed in March 2023 and showed significant improvement across all disciplines.

Conclusions: By embracing a system that supports ongoing evaluation, the ART has transformed care delivery resulting in efficient use of resources, improved outcomes, and staff engagement. ART has created a process that can adapt to meet the needs of a changing and challenging healthcare environment.