Code critical airway teams improves patient safety

Introduction

It takes an experienced multiprofessional team to handle emergent airway situations. We created a Code Critical Airway team to manage airway emergencies. Critical (difficult) airway emergencies are increasing due to advances in medical treatments, obesity and sleep apnea. Difficult airway events are low volume and high risk, requiring expert skill and communication. In the United States a leading level I adverse patient safety event is 'death or serious disability associated with airway management' [1].

Methods

Utilizing a complex framework with the goal of successful airway management outcomes, the project was divided into six components: patient safety, includes the development of an airway management plan focused on improved team efficiency and culture change from Panic Button to Bridge to Safety; patient assessment, includes the development of educational programs focusing on early recognition of potential critical airway patients; teamwork, includes the development of improved communication, paging and handoff processes; performance improvement, includes after-action reviews of each event to assess and address system and process issues; equipment, includes the development of standardized airway equipment at the bedside; and team simulation training, includes consistency in communication, handoff, teamwork and equipment use.

Results

The average time to establish an airway across all techniques has been drastically reduced (55 minutes to 22 minutes), of special note is the dramatic improvement in the time to reintubation (18 minutes to 5 minutes). The number of surgical airways required reduced from five pre-project to zero in phase two. Thirty-one percent of the airway patients were obese or had a short thick neck. We have seen an increase in our respiratory distress calls versus respiratory arrest calls, reinforcing the benefit of proactive over reactive calling. Code Critical Airway education programs improved the number of appropriate Code Critical Airways being called, as well as improved overall Code Critical Airway Team response time. As a by-product of this process, reliability of available appropriate airway equipment is now 100%.

Conclusions

This project made significant process improvements in the areas of patient safety, team communication, equipment availability and response efficiency. Hospitals should develop a specialized airway team to decrease adverse airway events.