Study protocol for the SECURE (RAFT-5) study: Service Evaluation of in-hospital Cross-speciality UK adult Rapid...

Rapid sequence intubation has evolved substantially since its inception over 50 years ago. Contemporary in-hospital rapid sequence intubation practice includes a combination of variably employed components, many of which lack robust supporting evidence. Real-world practice and the beliefs underpinning it are poorly characterised. We present the protocol for SECURE (Service Evaluation of Cross-speciality United Kingdom Rapid Sequence Intubation Events), a prospective service evaluation which aims to characterise adult in-hospital rapid sequence intubation practice across the United Kingdom. SECURE will comprise three electronic surveys (with data collection windows): (1) a Site Survey (six weeks) assessing local resources and governance; (2) a Vignette-based Survey (seven weeks) exploring drivers of variation in self-reported rapid sequence intubation practice; and (3) an Activity Survey (14 days per site) capturing user-defined rapid sequence intubation events and immediate complications. Survey development followed the Consensus-Based Checklist for Reporting of Survey Studies and was reviewed by expert advisers. Data will be stored securely at the Sponsor site and analysed in collaboration with a statistician. SECURE will provide a national overview of in-hospital rapid sequence intubation practice, including variation in resources and decision-making and describe the incidence of immediate complications. Formally recognised as a service evaluation, the study will be registered with information governance departments and represents the fifth project of the Research and Audit Federation of Anaesthetists in Training, overseen by the SECURE Investigation Group. Findings will inform future recommendations, investment and research in rapid sequence intubation practice.