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Decreasing Time from Decision to Intubation in Premedicated Neonates: A Quality Improvement Initiative
Tara J Glenn1,2, Melissa M Grathwol1, Jacquelyn D McClary1
1Department of Pediatrics, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH, USA.
Insights
Streamlining endotracheal intubation with premedications significantly reduced the decision-to-intubation time by 33% in neonates. This improvement enhances safety and efficiency without increasing adverse events.
Area of Science:
- Neonatal medicine
- Pediatric critical care
- Anesthesiology
Background:
- Endotracheal intubation risks include patient discomfort, trauma, and tube malposition.
- Premedications improve intubation safety, pain control, and first-pass success.
- Timely administration of premedications is often hindered by time constraints.
Purpose of the Study:
- To decrease the decision-to-intubation time interval in nonemergent neonatal intubations.
- To reduce the mean time from 40 minutes to under 35 minutes within 6 months.
Main Methods:
- Utilized the Model for Improvement with multiple plan-do-study-act cycles.
- Focused on timely medication administration, personnel/equipment availability, and efficient workflow.
- Applied to nonemergent neonatal intubations.
Main Results:
- Reduced mean decision-to-intubation time from 40 to 27 minutes (33% decrease).
- Achieved 80% of intubations within the target 35 minutes.
- Maintained stable success rates and did not increase medication errors or side effects.
Conclusions:
- Standardized processes for premedication preparation and administration effectively reduced intubation time.
- Achieved safe and timely premedication benefits in nonemergent neonatal intubations.
- Demonstrated improvement in efficiency without compromising patient safety.
Abstract:
Endotracheal intubation carries the risk of discomfort, decompensation, oral trauma, and endotracheal tube malposition. Treatment with premedications reduces complications, increases overall intubation safety, improves pain control, and improves first-pass success. However, time is frequently a barrier to administration. We aimed to decrease the decision-to-intubation time interval from a baseline of 40 minutes to less than 35 minutes over 6 months.
Methods:
We used the Model for Improvement with multiple plan-do-study-act cycles to reduce the time from decision to successful intubation in nonemergent neonatal intubations. Key drivers were timely administration of medications, availability of skilled personnel and equipment, and efficient use of time.
Results:
During this project, time from the decision to successful intubation decreased from a historical mean of 40 minutes to a new baseline of 27 minutes. This change represents a 33% decrease, with 80% of intubations occurring within 35 minutes. During this time, success rates remained stable, and medication errors and side effects did not increase.
Conclusions:
Standard processes to prepare and administer premedications decreased the time from decision to intubation without significant adverse effects, allowing the benefit of premedication administration in a safe and timely manner in nonemergent neonatal intubations.
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