DOI: 10.1097/01.ccm.0000458280.69287.e2
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Issn Print: 0090-3493
Publication Date: 2014/12/01
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Excerpt
Methods: The study was conducted at Children’s Healthcare of Atlanta and included all 5 intensive care units between 12/1/12 – 6/30/13. A planning workshop was held including respiratory care, nursing and quality leaders. An airway huddle process was developed to standardize UPE data collection. In addition, risks and interventions related to UPE were identified by the workshop members and a RAS was developed. The RAS was documented on each intubated patient on each shift (at 0400 and 1600, daily). Each patient would receive a score between 0–15. A RAS of 0–2 was defined as low risk, 3–4 as moderate risk, 5 as high, and >5 as extreme risk. The RASs for all intubated patients were extracted from electronic health records and UPEs were identified using an internal system-wide notification system. Huddle data were reviewed for each UPE classified as D2 and above (required re-intubation). For each patient median, mean and maximum RAS were calculated and compared for patients with and without UPE using two sample t-tests for means and Kolmogorov-Smirnov tests for equality of distributions.
Results: Compared to 823 patients with no UPE, 44 patients with an UPE (D2 and above) had a higher median RAS (3.13 vs 2.20, p=0.002), higher mean RAS (mean: 3.30 vs 2.29, p<0.001) and higher mean maximum RAS (6.06 vs 3.40, p<0.001). The distribution of median, mean and maximum RAS for each patient had larger values for those who had an UPE (p<0.001)
Conclusions: Higher RAS values are associated with patients that had an UPE. The RAS could help identify patients at higher risk of UPE so that appropriate interventions or monitoring could be instituted to enhance patient safety.
