Improving Safety of Emergency Out-of-Theatre Intubations in an Acute NHS Trust using Stakeholder Engagement in the Development of an Intubation Checklist


Background and Goal of Study
Critically ill patients in the intensive care unit (ICU) and emergency department (ED) may require tracheal intubation. Limited physiological reserve of these patients, lack of staff familiarity with, and the logistical challenges of out-of-theatre intubations (OOTI) make this procedure especially hazardous. The fourth National Audit Project1 (NAP4) reported that failure and complications during OOTI were more frequent than those in theatre. It recommended the development of an intubation checklist for all ED and ICU intubations1. Stakeholder engagement is well recognised in underpinning the success of implementing change from Quality Improvement Projects (QIP)2, 3 and therefore was used in the development and implementation of a checklist to improve the safety of OOTIs at Bucks Healthcare NHS Trust (BHNT).
Materials and Methods
84 staff members from the multi-disciplinary team (MDT) involved in emergency OOTI (including doctors, nurses and operating department practitioners from Anaesthetics, ICU and ED) at Stoke Mandeville Hospital were given a five-question survey over six weeks. The survey asked respondents their views on the use of an OOTI checklist, and their preferred option of two checklists: Checklist 1 was a modified prehospital intubation checklist, and Checklist 2 was an example provided in NAP4.
Results and Discussion
83 staff members returned completed questionnaires. 90% believed an OOTI checklist would be useful, of which 92% preferred Checklist 2. 45% of respondents recommended adjustments to Checklist 2.
Conclusion
Stakeholder engagement was instrumental in the development of this OOTI checklist. By engaging the MDT their experience and knowledge was shared and influenced the outcome. Checklist 2 will be modified, based upon the recommendations from this study, and implemented BHNT, in line with the NAP4 recommendations.
References
(1) Cook TM, et al. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Br J Anaesth 2011; 106: 632–42
(2) NHS England/Nursing/LTC. MDT Development – Working toward an effective multidisciplinary/multiagency team. NHS England. 2014
(3) Rowling E. Leadership and Engagement for Improvement in the NHS: together we can. Report from The King’s Fund Leadership Review. 2012

Improving safety of emergency out-of-theatre intubations in an acute NHS Trust using stakeholder engagement in the development of an intubation checklist