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Improving Documentation of Endotracheal Intubations in the Medical Intensive Care Unit at a Tertiary Care Hospital
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A6820 - Improving Documentation of Endotracheal Intubations in the Medical Intensive Care Unit at a Tertiary Care Hospital
Author Block: B. Lindgren1, P. Azizad-Pinto1, O. Rojanapairat1, U. Hoang2; 1Cedars-Sinai Medical Center, Los Angeles, CA, United States, 2Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, United States.
Introduction: Endotracheal intubation is a vital intervention for critically ill patients with respiratory failure. Delays in endotracheal intubation are associated with adverse outcomes. Complete documentation of the intubation procedure can guide clinicians in future intubations to increase success rates and minimize delays.
Methods: Retrospective review of consecutive patients that underwent endotracheal intubation by pulmonary and critical care fellows and attendings at Kaiser LAMC medical intensive care unit from 1/1/16 and 12/31/16. Data collected from each intubation included the level of training of the proceduralist (fellow or attending), indication for intubation, type of intubation (direct laryngoscopy (DL) vs. video laryngoscopy (VL) vs. bronchoscopic (B)), number of intubation attempts, Cormack-Lehane (C-L) classification system for grade view, and use of procedural medications. We deemed a note to be complete if it included the following: indication for intubation, type of intubation (DL, VL, B), number of intubation attempts, use of C-L classification system, and name and dose of procedural medications used. The data was presented at a quality improvement conference, a revised intubation template was initiated, and compliance with template was evaluated via chart review from 7/1/17 to 9/30/17.
Results: 256 patients were included in the initial data collection. Intubations were primarily performed by second year fellows (36%), followed by first year fellows (31%), attending physicians (28%), and third year fellows (4%). Only 12% of intubation notes qualified as being complete (32/256) with the majority performed by second year fellows. The most common missing documentation was the C-L classification system (76%) followed by intubation attempts (58%). Propofol was the most commonly used sedative (43%). Only 20% of clinicians used a paralytic agent. After the initiation of the revised intubation template, the number of complete notes performed by fellows increased from 14.3% (26/182) to 60% (21/35).
Conclusions: Our study demonstrated a significant increase in the number of complete intubation notes following a simple quality improvement initiative. We plan to analyze the data and identify practices that lead to more successful first pass intubations as well as create an educational curriculum for airway management for incoming fellows.
Author Block: B. Lindgren1, P. Azizad-Pinto1, O. Rojanapairat1, U. Hoang2; 1Cedars-Sinai Medical Center, Los Angeles, CA, United States, 2Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, United States.
Introduction: Endotracheal intubation is a vital intervention for critically ill patients with respiratory failure. Delays in endotracheal intubation are associated with adverse outcomes. Complete documentation of the intubation procedure can guide clinicians in future intubations to increase success rates and minimize delays.
Methods: Retrospective review of consecutive patients that underwent endotracheal intubation by pulmonary and critical care fellows and attendings at Kaiser LAMC medical intensive care unit from 1/1/16 and 12/31/16. Data collected from each intubation included the level of training of the proceduralist (fellow or attending), indication for intubation, type of intubation (direct laryngoscopy (DL) vs. video laryngoscopy (VL) vs. bronchoscopic (B)), number of intubation attempts, Cormack-Lehane (C-L) classification system for grade view, and use of procedural medications. We deemed a note to be complete if it included the following: indication for intubation, type of intubation (DL, VL, B), number of intubation attempts, use of C-L classification system, and name and dose of procedural medications used. The data was presented at a quality improvement conference, a revised intubation template was initiated, and compliance with template was evaluated via chart review from 7/1/17 to 9/30/17.
Results: 256 patients were included in the initial data collection. Intubations were primarily performed by second year fellows (36%), followed by first year fellows (31%), attending physicians (28%), and third year fellows (4%). Only 12% of intubation notes qualified as being complete (32/256) with the majority performed by second year fellows. The most common missing documentation was the C-L classification system (76%) followed by intubation attempts (58%). Propofol was the most commonly used sedative (43%). Only 20% of clinicians used a paralytic agent. After the initiation of the revised intubation template, the number of complete notes performed by fellows increased from 14.3% (26/182) to 60% (21/35).
Conclusions: Our study demonstrated a significant increase in the number of complete intubation notes following a simple quality improvement initiative. We plan to analyze the data and identify practices that lead to more successful first pass intubations as well as create an educational curriculum for airway management for incoming fellows.
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