Intubation Complication
Conditions
Keywords
Pediatric, Intubation, PICU, Safety
Brief summary
The purpose of the study is to implement a patient-provider dyad tailored, Electronic Health Record (EHR)-informed, digitized Smart Checklist as a Quality Improvement (QI) intervention to support bedside clinician teams to reduce Adverse Airway Outcomes (AAO) across 6 diverse pediatric intensive care units (ICUs).
Detailed description
More than 20% of the critically ill children who require tracheal intubation suffer from adverse events. To reduce the adverse event risk, and optimize bedside team performance investigators will implement a digitized Smart Checklist that has three specific features: (1) prompts based on patient characteristics, (2) direct display of difficult airway status and airway information, and (3) high-risk warning based on predictive analytics. This is a stepped-wedge cluster randomized trial of PICU patients who are intubated across 6 participating hospitals to determine if the Smart Checklist reduces the incidence of adverse tracheal intubation associated events. The primary objective of this study is to determine the clinical impact of the personalized, dynamic, adaptive Smart Checklist implementation on the occurrence of Adverse Airway Outcomes (AAOs) in the pediatric ICU. The secondary objective is to characterize work systems and processes that affect clinical impact of the digitized Smart Checklist.
Interventions
OTHERSmart Checklist
The digitized Smart Checklist includes three new features that currently do not exist on a paper checklist: 1) decision support prompts based on patient-provider dyad characteristics, 2) real time display of patient pertinent airway information from the EHR, and 3) high-risk warning alerts based on predictive analytics with potential explanatory factors from the model.
Sponsors
Agency for Healthcare Research and Quality (AHRQ)
Children's Hospital of Philadelphia
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
No minimum to 19 Years
Healthy volunteers
No
Inclusion criteria
All patients intubated in the PICU at participating sites
Exclusion criteria
Endotracheal tube exchanges, as this represents a distinct procedure
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Adverse Airway Outcomes | During the intubation procedure and up to 20 minutes after procedure | A composite outcome for adverse events or acute oxygen desaturation \<80% |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Duration of invasive mechanical ventilation | During the ICU stay, up to 180 days | Duration of invasive mechanical ventilation (time to extubation or tracheostomy) |
| Duration of ICU stay | During the ICU stay, up to 180 days | Duration of ICU stay (days) |
| ICU mortality | During the ICU stay, up to 180 days | ICU mortality (all cause) |
Countries
United States
Contacts
Primary ContactAkira Nishisaki, MD, MSCE
Backup ContactHayley Buffman, MPH
Outcome results
None listed