Video review to ensure qa during emergency intubations in a global pandemic: A pilot study

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has provided many obstacles for healthcare providers. One challenge has been ensuring safety during high risk procedures such as Emergency Department (ED) intubations. The risks include little preparation time, aerosolizing nature of the procedure, and unknown COVID status. Video review has shown effectiveness in quality improvement in critical care scenarios. We aimed to determine the feasibility of using video review of ED intubations in order to gather data about these events and enact change to improve provider safety. METHODS: We captured select videos of intubations that occurred in the COVID-19 pandemic in an audiovisual capable critical care bay. Each video was captured in real time and reviewed for intubation characteristics, intubator characteristics, exposure risk, and PPE compliance. RESULTS: The majority of the intubations were emergent (88.9%). Five patients (55.6%) were in cardiac arrest. The final COVID status was negative in 8 patients (88.9%). In most cases, a senior resident or attending was the intubating provider (77.8%). The mean number of intubation attempts was 1.1 (SD 0.33). The mean number of providers present at intubation was 3.9 (SD 1.97). The mean number of nurses and technicians present was 3 (SD 0.67) and 1.4 (SD 0.97), respectively. On average, the door to the room was opened 13.67 times (range 1-40). Provider PPE compliance was 100%. All intubating providers wore a powered air purifying respirator. All others present wore an N95 mask, gloves, gown, and eye protection. CONCLUSIONS: Video review of emergency intubations was a feasible means of evaluating provider safety and quality assurance during a global pandemic. Video review is an effective manner of evaluating adherence to PPE guidelines. It can also identify areas for improvement, such as limiting the number of providers in the room and limiting exposure to others by minimizing door-opening. These data were used to improve our intubation process. We implemented the use of pre-prepared airway boxes for each critical care bay, and walkie-talkies to communicate to those outside of the room to minimize door opening. Video review remains a fruitful and open space for quality improvement innovation and furthering the safety of patients and providers.