Difficult Intubation Alert Is Associated With a Reduced Incidence of Difficult Intubation

Area of Science:

• Anesthesiology
• Quality Improvement
• Patient Safety

Background:

• Difficult or failed tracheal intubation poses significant risks of morbidity and mortality.
• Prior documentation of difficult intubation is a strong predictor of future airway management challenges.

Purpose of the Study:

• To implement and evaluate a redesigned, highly visible difficult intubation alert within an electronic health record.
• To determine if the improved alert system reduces the incidence of difficult intubations.

Main Methods:

• A quality improvement project redesigned the difficult intubation alert for increased visibility in the EHR.
• Criteria for predicted difficult intubation included awake intubation, charted "difficult/unable", >3 attempts, or grade 3-4 laryngoscopy view.
• An alert was triggered if an anesthesia clinician charted an intubation as difficult, prompting addition to the patient's problem list.

Main Results:

• Alert application increased from 9% to 38% post-intervention (p<0.001).
• The monthly median percentage of predicted difficult intubations that were actually charted as difficult decreased significantly from 68% to 42% (p<0.001).

Conclusions:

• The implementation of a redesigned difficult intubation alert was associated with a reduced incidence of difficult intubation.
• Enhanced EHR alerts can improve the accuracy of difficult intubation documentation and potentially patient outcomes.