Failures of airway management (e.g., unplanned extubation, failure to intubate) are major causes of inpatient morbidity and mortality. The following steps will establish an institutional, team-based, comprehensive and sustainable system for reliability in airway management.
- Assemble a core multidisciplinary leadership team to advance airway safety, including:
- ED, ICU, Hospitalist, and Anesthesiology Physician Leader.
- ED, ICU Nursing Leaders.
- Respiratory Therapy Leaders.
- QA/Safety Leadership (VP or higher level).
- Establish the need for improvement by examining current vulnerabilities, using known and simulated complications and difficult cases, along with key statistics.
- Create the vision of institution-wide reliability for airway management safety through standardization of best practices, policies and procedures.
- Under the leadership of a physician anesthesiologist, develop a comprehensive airway toolkit method (e.g., the Safer Airway Bundle1). Start implementation in the ED and ICUs, and then move to floor units and other departments. Include the following Key Components: Failed Airway Path, Airway Cart, Airway Checklist, Quality Assurance, and Team Training:
- Implement Safer Airway Essential Components, as described in Appendix A.
- Require tracking and reporting of “near misses” and complications of airway management. Identify adverse outcomes that are iatrogenic and preventable. Use these case data in medical staff educational sessions to prevent recurrences, as a part of Continuous Quality Improvement (CQI).
- Provide periodic airway management education for all care providers. This will include: identification of airway problems, selection and use of appropriate intervention, and understanding when and how to call for expert assistance (e.g. from Anesthesiology).
Between the 2017 World Patient Safety, Science & Technology Summit and the 2017 Midyear Planning Meeting a workgroup comprised of experts representing administrators, clinicians, technologists and patient advocates will meet to update this APSS. If you are interested in joining this workgroup, please email us.