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 ??