![]() ![]() The patient needs at least one or two secure intravenous lines in place. ![]() ![]() We assemble and check all the equipment that we might require. We will also make our plan for what we will do for a failed airway if that occurs. If the evaluation indicates a difficult airway, we will call for help and will use the difficult airway plan (perhaps an awake intubation if time permits. The first thing we do is to assess the patient for difficulty of intubation and for difficulty of bag mask ventilation if intubation fails. These are the steps we follow once the decision that intubation, for ventilatory support or for airway protection, is needed. RSI is a procedure with seven steps: The Seven Ps of RSI (1) This is of paramount importance to us as providers and to our community as a whole.In rapid sequence intubation we administer an induction agent, often etomidate, and a neuromuscular blocking agent (NMBA), succinylcholine or rocuronium, to render the patient unconscious and paralyzed for an emergency intubation after a period of preoxygenation and sometimes pretreatment with other medicines. Overall, implementation of quality and performance improvement strategies can mitigate the occurrence of adverse events and lead to improved health outcomes for our patients. Continuous evaluation of FPS and the incidence of RSI-related complications will allow for assessment of not only our quality improvement initiative, but of our educational methodology as well. Furthermore, our clinical skills training process involves an integrative approach, pioneered by our interdisciplinary team of educators. Integration of a checklist in the RSI procedure will help to increase FPS rates and act as a method to aid in continuous evaluation and improvement of overall airway performance.Īlthough many airway performance improvement studies exist, our institution is unique in that we are a new Emergency Medicine (EM) Residency program that will be comprised of only post-graduate year 1 (PGY1) and post-graduate year 2 (PGY2) EM residents at the commencement of data collection. The introduction of checklists as a process improvement tool has been identified as a successful strategy for improving the effectiveness and quality of procedures throughout healthcare. To maximize FPS and increase the safety of the procedure, it is essential to develop a tool to maximize efficacy. Thus, establishing effective methods of decreasing the occurrence of failed attempts will result in an immediate reduction of unintended issues. The number of failed intubation attempts (3+) has been directly correlated with the an increased development of complications. According to the 4th National Audit Project of the Royal College of Anesthetists, it was determined that 30% of patients in the ED and 60% of patients in the ICU experiencing an airway related incident, suffered brain damage or death. These complications commonly lead to poor or life-threatening outcomes and include desaturation, hypotension, dysrhythmia, cardiac arrest, pneumothorax, dental trauma, and esophageal intubation. Unfortunately, many complications can arise during RSI, the incidence of which has remained high. According to a variety of studies published over the last decade, including a large, multi-center systematic review and meta-analysis, the mean FPS rate (84%) has been used as an institutional benchmark for ED airway proficiency. ![]() First-pass success (FPS) in Rapid Sequence Intubation (RSI) is the most commonly utilized metric for evaluation and allows for comparison across clinical environments. Why Should I Register and Submit Results?Ĭontinuous evaluation and improvement of airway performance in the Emergency Department (ED) is essential for achieving positive clinical outcomes and reducing the incidence of related adverse events. ![]()
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