The safety checklist was created by a team of surgeons, critical care nurses, respiratory therapists, and trauma technicians at Cooper University Hospital in Camden, N.J., and focused on preprocedural setup, procedural steps, and a group timeout process.
In the equipment setup phase, the bedside nurse, respiratory therapist, and trauma technician must assemble and test all necessary equipment.
During the timeout process, team members are introduced, the nurse confirms the patient, the planned procedure, positioning of the patient, medications, and equipment, and the surgeon discusses any critical steps or steps that may be unique to the patient. Finally, each team member is given an opportunity to discuss any concerns or ask any questions prior to proceeding.
“The idea of this checklist is to bring the team together, so if there is one member of the team who doesn’t feel right about the procedure or has concerns, the procedure is stopped,” said Dr. Hazelton of the department of surgery at Cooper.
The last phase of the checklist is a postprocedural assessment to make sure the tracheostomy is properly secured and the patient is stable.
To assess its impact, the investigators prospectively analyzed all 63 patients who underwent bedside tracheostomy at the level I trauma center from checklist implementation July 1, 2013 to June 30, 2014 and compared them with 184 historical controls who underwent bedside tracheostomy without the checklist from July 1, 2011 to June 30, 2013. All tracheostomies were performed using the Blue Rhino Percutaneous Tracheostomy Kit (Cook Medical).
The pre- and postchecklist groups had similar numbers of patients with potentially difficult airways including those with cervical spine fracture (30 patients vs. 4 patients; P = .056), cervical ligamentous injury (3 vs. 0; not significant), occipital condyle fracture (3 vs. 0; NS), cervical spinal cord injury (4 vs. 2; NS), mandible fracture (8 vs. 2; NS), LeFort III fracture (5 vs. 1; NS), or oral cavity injury (5 vs. 1; NS).
Prechecklist patients were younger than postchecklist patients (48 years vs. 57 years; P = .001), but all other baseline characteristics were well matched including gender, body mass index, duration of mechanical ventilation, heart rate, mean arterial pressure, and oxygen saturation.
The pre- and postchecklist groups had the same occurrence of individual adverse procedural events including loss of airway (2 vs. 0; P = 1.0), deterioration in respiratory parameters during procedure (7 vs. 2; P = 1.0), hemodynamic compromise (19 vs. 2; P = .079), need for vasopressors or antiarrhythmics are (1 vs. 0; P = 1.0), and conversion to open procedure (5 vs. 0; P = .333). But overall, the postchecklist group experienced significantly fewer adverse events (3.2% vs. 14.7% prechecklist; P = .014), Dr. Hazelton said.