Reducing Time to Postintubation Sedation in a Pediatric Emergency Department

Area of Science:

• Pediatric Emergency Medicine
• Quality Improvement Science
• Patient Safety

Background:

• Inadequate postintubation sedation (PIS) is linked to adverse events like unplanned extubations.
• A pediatric emergency department observed that only ~25% of children received timely PIS, with 2 endotracheal tube dislodgements.
• The existing mean time to PIS was 39 minutes.

Purpose of the Study:

• To decrease the mean time to initiate PIS from 39 minutes to under 15 minutes.
• To improve patient care and safety in the pediatric emergency department.
• To achieve this goal by September 2021.

Main Methods:

• A multidisciplinary team developed a standardized PIS protocol using a key driver diagram.
• Plan-do-study-act cycles guided interventions including education and checklist development.
• Data were analyzed using X-bar and S charts, measuring time to PIS and unplanned extubations.

Main Results:

• Initial protocol implementation reduced mean time to PIS from 39 to 21 minutes.
• Further interventions led to a sustained mean time to PIS of 13 minutes over 9 months.
• No episodes of PIS-related hypotension or unplanned extubations were observed post-intervention.

Conclusions:

• Quality improvement methodologies effectively reduced PIS initiation time in a pediatric emergency setting.
• The study demonstrated a sustained improvement in patient safety through standardized sedation practices.
• This approach successfully minimized critical adverse events associated with inadequate postintubation sedation.