Checklist dramatically improves safety of bedside tracheostomy
AT THE EAST SCIENTIFIC ASSEMBLY
Discussant Dr. Bradley Dennis of Vanderbilt University Medical Center in Nashville, Tenn., said, “I don’t think we even need P values to identify this as a successful intervention, so I commend you for your excellent work.”
As bedside surgical procedures become more prevalent, it only stands to reason that the same patient safety measures used in the OR would be extended into the ICU, he said. Indeed, Vanderbilt has employed a preprocedure checklist for all procedures in the surgical trauma ICU since 2007, but unfortunately did not measure the outcomes prospectively.
Dr. Dennis went on to ask whether there were any patients in whom the checklist identified something that caused the team to abort the procedure.
Early in the process, there were several near-misses that were difficult to categorize, but typically revolved around not having a specific piece of rescue equipment in the room such as an airway box, Dr. Hazelton said. One particular case also raised concerns on the part of the respiratory therapist because of the patient’s large head, short neck, and body habitus, and after discussion, the procedure was halted.
“It was done in the operating room the next day and my colleague who performed that procedure told me it was somewhat challenging, a difficult cut down, a T-bar wing,” he said. “But certainly, that level of trust in your other colleagues, nursing, technicians, respiratory, is necessary for success of this kind of checklist.”
Dr. Hazelton and his coauthors reported having no financial disclosures.
