Critical Airway Management: In a Teaching Institution Manu Malhotra & Jennifer Ritz

Airway Management Team A Multidisciplinary Approach ER- MD/RN ICU- Surgical/Medical/Neuro Acute Care Surgery Anesthesia Otolaryngology Cardiology Gastroenterology Interventional Radiology Clinical Nurse Specialists Pharmacy Respiratory Therapy Rapid Response Team Transitional Resident Medical Student Quality/Risk

AIM Standardize the practice of airway management across HFH in order to optimize patient outcomes and minimize patient harm using a multidisciplinary approach

Objectives Establish a standardized definition of difficult airway and a standardized approach to prospectively identify such cases Establish a standardized process/algorithm for intubation and for difficult airway management Create an airway management checklist that will be utilized in all departments and in all settings Establish communication mechanism to alert providers of patients with known history of difficult airway Create and offer a Simulation Lab curriculum for airway management

Meetings Meet once a month Break out into teams to address the following

Scope of the project Objectives –To create an airway management safety checklist that will be utilized in all departments and all settings.

Scope of the project Intubation Management Weaning Extubation

Scope of the project Intubation Management Weaning Extubation

Scope of the project Pre-intubation Intubation Immediate post-intubation

Initial Approach and Scoping Establish Current State –Gather literature and best practices –Query current practices in all HFH sites Creation of standardized guidelines –Checklist –Standardized process Education and maintenance of competency –Sim Lab

Scope of the project Objectives –To establish a standardized definition of difficult airway and a standardized approach to prospectively identifying such cases.

Scope of the project Objectives –To establish a mechanism of communication to alert providers of patients with a known history of difficult airway.

Scope of the project Objectives –To establish a standardized process/algorithm for intubation and for difficult airway management.

Scope of the project Objectives –To create and offer a Simulation Lab curriculum for airway management.

Multidisciplinary Work Groups Group 1: Standardized Intubation Practices (aim #2 and 3) –Algorithm for intubation Equipment available during procedure Number of attempts per clinician Group 2: Difficult Intubation (aim #1, 2 and 3) –When unable to intubate what steps are taken –Airway Response Team

Multidisciplinary Work Groups Group 3: Training/Competency for Emergency/Difficult Airway –Education rollout –Sim Lab Education –ACLS Training –Credentialing

Measures of success Decrease # of sentinel events (to zero) Decrease # of Catastrophic/Serious/Moderate events Decrease # of Severity 1,2,3 events as percentage of total ??