Adoption of video laryngoscopy in Massachusetts emergency departments

Previous research suggests that video laryngoscopy may be superior to direct laryngoscopy.

We sought to determine the proportion of Massachusetts emergency departments (EDs) that have adopted video laryngoscopy, the characteristics of user and non-user EDs, the reasons why non-users do not use video laryngoscopy, and how the adoption of video laryngoscopy compares to typical technology adoption life cycles.

Surveys were mailed to directors of all non-federal EDs in Massachusetts (n=74) in early 2009. Non-responders received repeat mailings and were then contacted via telephone or e-mail.

Sixty-three of 74 (85%) EDs responded and 43% had adopted video laryngoscopy. EDs with video laryngoscopy had a higher median annual visit volume than EDs without video laryngoscopy (48,000 vs. 36,500, p=0.04), but had similar mean intubations per week (4.5 vs. 4.4, p=0.97) and mean surgical airways per year (0.7 vs. 1.1, p=0.19). Half of the EDs affiliated with emergency medicine residency programs had video laryngoscopy available. Among EDs with video laryngoscopy, the technology had been available for>5 years in 4% (1/27), 1-5 years in 44% (12/27), and<1 year in 52% (14/27). Although EDs not using video laryngoscopy did not do so primarily because it was too expensive (69% [25/36]), video laryngoscopy adoption has still progressed more rapidly than predicted by the typical technology adoption timeline.

Video laryngoscopy has been adopted by 43% of Massachusetts EDs; results were similar in academic institutions. Cost is the primary barrier to adoption for non-user EDs, but adoption is progressing more rapidly than expected for a new technology.