Translational Simulation Improves Compliance with the NEAR4KIDS Airway Safety Bundle in a Single-center PICU.

• Type of Material: Article
• Authors: Nora Colman, Emory University; Jordan W Newman, Department of Pediatrics, Division of Pediatric Critical Care, Children's Healthcare of Atlanta, Atlanta, Ga.; Akira Nishisaki, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, The University of Pennsylvania Perlman School of Medicine, Philadelphia, Pa.; Melinda Register, Department of Pediatrics, Division of Pediatric Critical Care, Children's Healthcare of Atlanta, Atlanta, Ga.; Scott E Gillespie, Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga.; Kiran Hebbar, Emory University
• Language: English
• Date: 2021-05
• Publisher: PQS
• Publication Version: Final Published Version
• Copyright Statement: © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/pq9.0000000000000409
• Title of Journal or Parent Work: Pediatr Qual Saf
• Volume: 6
• Issue: 3
• Start Page: e409
• End Page: e409
• Keywords: Translational Simulation; Single-center PICU
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

The National Emergency Airway Registry for Children (NEAR4KIDS) Airway Safety Quality Improvement (QI) Bundle is a QI tool to improve the safety of tracheal intubations. The ability to achieve targeted compliance with bundle adherence is a challenge for centers due to competing QI initiatives, lack of interdisciplinary involvement, and time barriers. We applied translational simulations to identify safety and performance gaps contributing to poor compliance and remediate barriers by delivering simulation-based interventions. METHODS: This was a single-center retrospective review following translational simulations to improve compliance with the NEAR4KIDS bundle . The simulation was implemented between March 2018 and December 2018. Bundle adherence was assessed 12 months before simulation and 9 months following simulation. Primary outcomes were compliance with the bundle and utilization of apneic oxygenation. The secondary outcome was the occurrence of adverse tracheal intubation-associated events. RESULTS: Preintervention bundle compliance was 66%, and the application of apneic oxygenation was 27.9%. Following the simulation intervention, bundle compliance increased to 93.7% (P < 0.001) and adherence to apneic oxygenation increased to 77.9% (P < 0.001). There was no difference in the occurrence of tracheal intubation-associated events. CONCLUSIONS: Translational simulation was a safety tool that improved NEAR4KIDS bundle compliance and elucidated factors contributing to successful implementation. Through simulation, we optimized bundle customization through process improvement, fostered a culture of safety, and effectively engaged multidisciplinary teams in this quality initiative to improve adherence to best practices surrounding tracheal intubations.