Improving Team Communication during intubation in the Critical Care Unit
CCCF ePoster library. Lopez Soto C. Oct 2, 2017; 198196; 16
Dr. Carmen Lopez Soto
Dr. Carmen Lopez Soto
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Improving Team Communication during intubation in the Critical Care Unit

Lopez Soto, C1,3; Lee, T2; Urner, M; Amaral, AC1,3; Goddard, S1,3

1Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada

2University of Toronto

3Interdepartmental Division of Critical Care, University of Toronto

Introduction: Critically ill patients that require intubation are at high risk of hypoxia and cardiovascular instability. One in 4 major adverse airway events occur in the intensive care unit or emergency department. Timely and effective communication among team members is crucial during this high-risk procedure. Evidence from military and pre-hospital medicine has shown that standardized checklists limit human error and improve team communication and patient safety. The aim of this project was to implement the use of a team time-out with the communication of an intubation plan and team member concerns and increase the use of these tools to up to 80% in ICU intubations. 


Methods: The study was conducted in medical-surgical intensive care units at two academic hospitals in Toronto. We identified current deficits in team communication by engaging stakeholders involved in intubations. We surveyed ICU nurses, physicians, and respiratory therapists to understand the perception of team efficacy in communication, equipment preparation, and patient safety and monitoring. We also audited ICU intubations to identify whether intubation plan, airway assessment, team concerns, and team member roles were verbalized prior to conducting the procedure. We used the survey and audit data to design and implement a pre-intubation communication tool. The implementation process involved 1) education sessions with physicians, respiratory therapists, and nurses, and 2) printed reminders in the ICU and intubation equipment cart. 


Results: Three main deficits in pre-intubation communication were identified. In the observed intubations, only 40% included team time outs, 70% had intubation plans verbalized, and 50% had team member concerns addressed. Fewer than 50% of survey respondents felt that any of these areas were consistently communicated during intubations. The final communication tool contained 6 components: 1) team time out, 2) indication for intubation, 3) team member roles, 4) equipment readiness, 5) intubation plan, and 6) final concerns. A post implementation audit and stakeholder survey is in progress. 


Conclusion: Intubation in critically ill patients is a high-risk procedure. Our assessment of current intubation practice identifies deficits in team communication that have potential impact on team member preparation and patient safety. We have implemented a bedside tool consisting of six key items. Educational sessions were provided to staff to understand and use the tool. We will be surveying the staff about usefulness of the tool and we are currently considering venues for futher dissemination like inter-professional rounds, in situ simmulation. 


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