“Implementing the actionable patient safety solution (APSS) pre-intubation checklist in the emergency department of the university teaching hospital of Kigali: a pre and post implementation study”

Abstract

Background: Airway management is one of the most important parts of practicing emergency medicine practice. Up to 1% of emergency patients may require intubation to treat conditions like respiratory failure, cardiac arrest and depressed mental status. Rapid sequence intubation (RSI) is one of the technics used to secure the airway. In the emergency department, it can be performed in a chaotic and stressful situation, which poses concerns about its safety. The generation of new policies and procedures can be implemented to generate transformative change for patient safety in airway management. Methods: This was a pre- and post-intervention cross sectional study carried out over a period of 4 months and 1 week. It consisted of 3 phases; Phase I: Pre intervention: observation of routine practice on endotracheal intubations, Phase II: Intervention: Training and mentorship on the use of the pre-intubation checklist during 1 week and Phase III: Post intervention: Observation while using pre-intubation checklist before intubation. We recorded sociodemographic information of participants, steps of intubation, the time used for intubation, medication and devices used, tube placement confirmation, post intubation care and possible intubation related complications for pre and post intervention phase. Results: Over the four months study period, seventy-seven (77) patients were enrolled in the study. 40 (51.9%) patients were intubated in Phase One and 37(48.1%) patients intubated during Phase Three. There was an increased adherence to steps of intubation during pre-intubation checklist use (post intervention phase). Overall, there was a reduction in ED patient intubated complications in Phase Three (35% VS. 24.7%), although this failed to reach statistical significance (p=0.306). Conclusion: Within the UTHK ED, there was an increase in adherence to essential steps of intubation among emergency residents. In addition, the use of the pre-intubation airway checklist during rapid sequence intubations was associated with a reduction in intubation-related complications even though this reduction was not statistically significant.