Rapid Improvement in Airway Safety Using a Model of Continuous Improvement

Sunday, February 23, 2025

11:45am – 12:45pm Eastern Time

Location: Connections Central Theater 1

Ilana Harwayne-Gidansky, MA, MD (she/her/hers)

Albany Medical Center

Disclosure(s): No relevant financial relationship(s) to disclose.
LW

Lesa Ward, NA

Educator, Respiratory Therapy
Bernard & Millie Duker Children's Hospital at Albany Medical Center

Disclosure information not submitted.
CP

Chad Pezzano, RT

Director of Pediatric Respiratory Therapy
Albany Medical Center

Disclosure information not submitted.
CA

Cynthia Avalos, NA

Medical Student
Albany Medical College

Disclosure information not submitted.
PJ

Pamela Jones, NA

Pediatric Quality Manager
Albany Medical Center

Disclosure information not submitted.
RD

Rachel Dente, NA

PICU Nurse Educator
Albany Medical Center

Disclosure information not submitted.
SA

Shashikanth Reddy Ambati, MD

Associate Professor of Pediatrics
Albany Medical Center

Disclosure information not submitted.
Akira Nishisaki, MD, MSCE (he/him/his)

Division of Critical Care Medicine, Department of Anesthesia and Critical Care
The Children's Hospital of Philadelphia

Disclosure information not submitted.

Disclosure(s):

Ilana Harwayne-Gidansky, MA, MD: No relevant financial relationship(s) to disclose.

Introduction: Pediatric tracheal intubation (TI) is a high-risk procedure with potential for tracheal intubation associated events (TIAE). Implementation of an airway bundle checklist (ABC) demonstrates TIAE reduction. Little is known about the impact of rapid implementation of best practices and innovative components to reduce TIAEs, beyond the ABC. This study aimed to quantify the effect of the NEAR4KIDS ABC and local Quality Improvement (QI) interventions utilizing a practical approach. The objective of this single center QI study was to evaluate the feasibility of the process and reduction of TIAEs beyond the ABC.

Methods: From 4/2022-4/2024, we used the Model for Improvement as a framework for harm reduction in our outcome (TIAE). The first year (baseline) we implemented the NEAR4KIDS ABC. In the next 2 years, we implemented interventions including standardizing practice, equipment, and competency matching, and video laryngoscopy (VL)/ apneic oxygenation (AO) implementation. These were evaluated both in real-time and simulated events. Process measures included ABC compliance and use of VL or AO. Statistical control charts and rules for special cause variation were used to evaluate change over time. Implementation effect was evaluated through a pre and posttest design.

Results: There were 145 TIs (61 baseline, 84 implementation), with about 13 intubations per quarter. There were 15 TIAEs (24.6%) in the baseline phase and 4 TIAEs (4.8%) in the implementation phase (p < 0.001). ABC use remained at or above the threshold of 80%. VL had higher usage in the implementation phase (61% vs 39% p=0.011). Fewer multiple attempts for TI occurred during the post-implementation phase (12.9% vs 27% p= 0.037), but not moderate desaturations ( < 80%). There was a reduction in quarterly TIAEs with 6 points below the network centerline of 13%, reflecting a possible shift in process. T-chart reflects special cause variation and a trend towards decreasing frequency of TIAE.

Conclusions: The integration of several best practice approaches in a model for improvement is feasible and may positively influence outcomes. Further research is recommended to validate and sustain these preliminary findings. This is an important case study to establish potential for improvement, and to better understand its impact over time.