Checklist dramatically improves safety of bedside tracheostomy

Key clinical point: A multidisciplinary checklist before percutaneous bedside tracheostomy can improve adverse event rates and overall safety.

Major finding: The overall adverse procedural event rate declined from 14.7% to 3.2% post checklist (P = .014).

Data source: Analysis of 247 patients who underwent percutaneous tracheostomy.

Disclosures: Dr. Hazelton and his coauthors reported having no financial disclosures.




LAKE BUENA VISTA, FLA. – Use of a multidisciplinary safety checklist prior to all bedside bronchoscopy-guided percutaneous tracheostomies was independently associated with a dramatic reduction in adverse procedural events, a study showed.

After adjustment for age, vitals, tracheostomy risk factors, and ICU duration after the procedure, multivariable logistic regression determined that no other factor – not age, baseline heart rate, baseline oxygen saturation, or difficult airway status – was significant against adverse procedural events except use of the checklist (odds ratio, 5.85; P = .022

Overall, in the postchecklist group, 3.2% experienced adverse events, compared with 14.7% in the prechecklist group.

Dr. Joshua Hazelton Patrice Wendling/Frontline Medical News
Dr. Joshua Hazelton

“We feel this checklist could be used by other institutions with similar success and also could be modified for other invasive bedside procedures,” lead study author Dr. Joshua Hazelton said at the annual scientific assembly of the Eastern Association for the Surgery of Trauma (EAST).

Bedside bronchoscopy-guided percutaneous tracheostomies (BBPT) are safe, yet like many bedside procedures are seldom subject to the same safety checklists and timeout processes that have become standard in the operating room, he observed. When asked specifically how the checklist improved safety, Dr. Hazelton said the multidisciplinary aspect of the checklist distills a sense of ownership in every team member. A significant amount of evidence published on the benefits of World Health Organization checklists also shows checklists improve communication and empower members to speak up if something doesn’t feel right.

“Most of all, the checklist helped to focus the team on a procedure that really has very little margin of error,” he said. “As we do more of these procedures, I think the tendency for the entire team can be to look at these procedures as almost routine, and certainly with an airway procedure, I don’t think you should look at it as a routine thing.”

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