Using a post-Intubation checklist and time out to expedite mechanical ventilation monitoring: Observational study of a quality improvement intervention

Ryan A. McConnell*, Meeta Prasad Kerlin, William D. Schweickert, Faraz Ahmad, Mitesh S. Patel, Barry D. Fuchs

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

BACKGROUND: Delayed mechanical ventilation monitoring may impede recognition of lifethreatening acidemia. Coordination of multidisciplinary processes can be improved by using a checklist and time-out procedure. The study objective was to evaluate process-related outcomes after implementation of a post-intubation checklist and time out. METHODS: An observational study of a 24-bed medical ICU in Philadelphia, Pennsylvania, was conducted from January to December 2011. A random sample of mechanically ventilated adults was selected from the preintervention (n = 80) and post-intervention (n= 144) periods. The primary outcome was the proportion of subjects with an arterial blood gas (ABG) result within 60 min of mechanical ventilation initiation. Secondary outcomes included rates of respiratory acidosis, moderate-severe acidemia (pH <7.25), checklist initiation, and project sustainability. Chi-square analysis was used to evaluate differences in outcomes between time periods. RESULTS: After the intervention, the proportion of subjects with an ABG result within 60 min increased (56% vs 37%, P= .01), and time to ABG result improved (58 min vs 79 min, P= .004). Adjusting for illness severity, the proportion with an ABG result within 60 min remained significantly higher in the post-intervention period (odds ratio 2.42, 95% CI 1.25– 4.68, P = .009). Checklist adherence was higher with ICU intubations than for intubations performed outside the ICU (71% vs 27% checklist initiation rate, P < .001). Transfer from referring institutions (23% checklist initiation rate, P = .006) negatively impacted checklist use. Implementation challenges included frequent stakeholder turnover, undefined process ownership, and lack of real-time performance feedback. CONCLUSIONS: A post-intubation checklist and time out improved the timeliness of mechanical ventilation monitoring through more rapid assessment of arterial blood gases. Implementing this peri-intubation procedure may reduce the risks associated with transitioning to full mechanical ventilatory support. Optimal implementation necessitates strategies to surmount organizational and behavioral barriers to change.

Original languageEnglish (US)
Pages (from-to)902-912
Number of pages11
JournalRespiratory care
Volume61
Issue number7
DOIs
StatePublished - Jul 1 2016

Keywords

  • Acidosis
  • Artificial respiration
  • Blood gas analysis
  • Checklist
  • Mechanical ventilators
  • Quality improvement

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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