Difficult airway response team: A novel quality improvement program for managing hospital-wide airway emergencies

Lynette J Mark, Kurt R. Herzer, Renee Cover, Vinciya Pandian, Nasir Islam Bhatti, Lauren C. Berkow, Elliott Haut, Alexander Tell Hillel, Christina Miller, David Feller-Kopman, Adam Schiavi, Yanjun J. Xie, Christine Lim, Christine Holzmueller, Mueen Ahmad, Pradeep Thomas, Paul W. Flint, Marek A Mirski

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Difficult airway cases can quickly become emergencies, increasing the risk of life-threatening complications or death. Emergency airway management outside the operating room is particularly challenging. METHODS: We developed a quality improvement program - the Difficult Airway Response Team (DART) - to improve emergency airway management outside the operating room. DART was implemented by a team of anesthesiologists, otolaryngologists, trauma surgeons, emergency medicine physicians, and risk managers in 2005 at The Johns Hopkins Hospital in Baltimore, Maryland. The DART program had 3 core components: operations, safety, and education. The operations component focused on developing a multidisciplinary difficult airway response team, standardizing the emergency response process, and deploying difficult airway equipment carts throughout the hospital. The safety component focused on real-time monitoring of DART activations and learning from past DART events to continuously improve system-level performance. This objective entailed monitoring the paging system, reporting difficult airway events and DART activations to a Web-based registry, and using in situ simulations to identify and mitigate defects in the emergency airway management process. The educational component included development of a multispecialty difficult airway curriculum encompassing case-based lectures, simulation, and team building/communication to ensure consistency of care. Educational materials were also developed for non-DART staff and patients to inform them about the needs of patients with difficult airways and ensure continuity of care with other providers after discharge. RESULTS: Between July 2008 and June 2013, DART managed 360 adult difficult airway events comprising 8% of all code activations. Predisposing patient factors included body mass index >40, history of head and neck tumor, prior difficult intubation, cervical spine injury, airway edema, airway bleeding, and previous or current tracheostomy. Twenty-three patients (6%) required emergent surgical airways. Sixty-two patients (17%) were stabilized and transported to the operating room for definitive airway management. There were no airway management-related deaths, sentinel events, or malpractice claims in adult patients managed by DART. Five in situ simulations conducted in the first program year improved DART's teamwork, communication, and response times and increased the functionality of the difficult airway carts. Over the 5-year period, we conducted 18 airway courses, through which >200 providers were trained. CONCLUSIONS: DART is a comprehensive program for improving difficult airway management. Future studies will examine the comparative effectiveness of the DART program and evaluate how DART has impacted patient outcomes, operational efficiency, and costs of care.

Original languageEnglish (US)
Pages (from-to)127-139
Number of pages13
JournalAnesthesia and Analgesia
Volume121
Issue number1
DOIs
StatePublished - Jul 4 2015

Fingerprint

Airway Management
Quality Improvement
Emergencies
Operating Rooms
Communication
Safety
Baltimore
Continuity of Patient Care
Emergency Medicine
Tracheostomy
Malpractice
Wounds and Injuries
Intubation
Causality
Curriculum
Reaction Time
Registries
Edema
Spine
Body Mass Index

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Difficult airway response team : A novel quality improvement program for managing hospital-wide airway emergencies. / Mark, Lynette J; Herzer, Kurt R.; Cover, Renee; Pandian, Vinciya; Bhatti, Nasir Islam; Berkow, Lauren C.; Haut, Elliott; Hillel, Alexander Tell; Miller, Christina; Feller-Kopman, David; Schiavi, Adam; Xie, Yanjun J.; Lim, Christine; Holzmueller, Christine; Ahmad, Mueen; Thomas, Pradeep; Flint, Paul W.; Mirski, Marek A.

In: Anesthesia and Analgesia, Vol. 121, No. 1, 04.07.2015, p. 127-139.

Research output: Contribution to journalArticle

Mark, Lynette J ; Herzer, Kurt R. ; Cover, Renee ; Pandian, Vinciya ; Bhatti, Nasir Islam ; Berkow, Lauren C. ; Haut, Elliott ; Hillel, Alexander Tell ; Miller, Christina ; Feller-Kopman, David ; Schiavi, Adam ; Xie, Yanjun J. ; Lim, Christine ; Holzmueller, Christine ; Ahmad, Mueen ; Thomas, Pradeep ; Flint, Paul W. ; Mirski, Marek A. / Difficult airway response team : A novel quality improvement program for managing hospital-wide airway emergencies. In: Anesthesia and Analgesia. 2015 ; Vol. 121, No. 1. pp. 127-139.
@article{be0b2d3b279f4ad2aaec51cdfa0134d4,
title = "Difficult airway response team: A novel quality improvement program for managing hospital-wide airway emergencies",
abstract = "BACKGROUND: Difficult airway cases can quickly become emergencies, increasing the risk of life-threatening complications or death. Emergency airway management outside the operating room is particularly challenging. METHODS: We developed a quality improvement program - the Difficult Airway Response Team (DART) - to improve emergency airway management outside the operating room. DART was implemented by a team of anesthesiologists, otolaryngologists, trauma surgeons, emergency medicine physicians, and risk managers in 2005 at The Johns Hopkins Hospital in Baltimore, Maryland. The DART program had 3 core components: operations, safety, and education. The operations component focused on developing a multidisciplinary difficult airway response team, standardizing the emergency response process, and deploying difficult airway equipment carts throughout the hospital. The safety component focused on real-time monitoring of DART activations and learning from past DART events to continuously improve system-level performance. This objective entailed monitoring the paging system, reporting difficult airway events and DART activations to a Web-based registry, and using in situ simulations to identify and mitigate defects in the emergency airway management process. The educational component included development of a multispecialty difficult airway curriculum encompassing case-based lectures, simulation, and team building/communication to ensure consistency of care. Educational materials were also developed for non-DART staff and patients to inform them about the needs of patients with difficult airways and ensure continuity of care with other providers after discharge. RESULTS: Between July 2008 and June 2013, DART managed 360 adult difficult airway events comprising 8{\%} of all code activations. Predisposing patient factors included body mass index >40, history of head and neck tumor, prior difficult intubation, cervical spine injury, airway edema, airway bleeding, and previous or current tracheostomy. Twenty-three patients (6{\%}) required emergent surgical airways. Sixty-two patients (17{\%}) were stabilized and transported to the operating room for definitive airway management. There were no airway management-related deaths, sentinel events, or malpractice claims in adult patients managed by DART. Five in situ simulations conducted in the first program year improved DART's teamwork, communication, and response times and increased the functionality of the difficult airway carts. Over the 5-year period, we conducted 18 airway courses, through which >200 providers were trained. CONCLUSIONS: DART is a comprehensive program for improving difficult airway management. Future studies will examine the comparative effectiveness of the DART program and evaluate how DART has impacted patient outcomes, operational efficiency, and costs of care.",
author = "Mark, {Lynette J} and Herzer, {Kurt R.} and Renee Cover and Vinciya Pandian and Bhatti, {Nasir Islam} and Berkow, {Lauren C.} and Elliott Haut and Hillel, {Alexander Tell} and Christina Miller and David Feller-Kopman and Adam Schiavi and Xie, {Yanjun J.} and Christine Lim and Christine Holzmueller and Mueen Ahmad and Pradeep Thomas and Flint, {Paul W.} and Mirski, {Marek A}",
year = "2015",
month = "7",
day = "4",
doi = "10.1213/ANE.0000000000000691",
language = "English (US)",
volume = "121",
pages = "127--139",
journal = "Anesthesia and Analgesia",
issn = "0003-2999",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Difficult airway response team

T2 - A novel quality improvement program for managing hospital-wide airway emergencies

AU - Mark, Lynette J

AU - Herzer, Kurt R.

AU - Cover, Renee

AU - Pandian, Vinciya

AU - Bhatti, Nasir Islam

AU - Berkow, Lauren C.

AU - Haut, Elliott

AU - Hillel, Alexander Tell

AU - Miller, Christina

AU - Feller-Kopman, David

AU - Schiavi, Adam

AU - Xie, Yanjun J.

AU - Lim, Christine

AU - Holzmueller, Christine

AU - Ahmad, Mueen

AU - Thomas, Pradeep

AU - Flint, Paul W.

AU - Mirski, Marek A

PY - 2015/7/4

Y1 - 2015/7/4

N2 - BACKGROUND: Difficult airway cases can quickly become emergencies, increasing the risk of life-threatening complications or death. Emergency airway management outside the operating room is particularly challenging. METHODS: We developed a quality improvement program - the Difficult Airway Response Team (DART) - to improve emergency airway management outside the operating room. DART was implemented by a team of anesthesiologists, otolaryngologists, trauma surgeons, emergency medicine physicians, and risk managers in 2005 at The Johns Hopkins Hospital in Baltimore, Maryland. The DART program had 3 core components: operations, safety, and education. The operations component focused on developing a multidisciplinary difficult airway response team, standardizing the emergency response process, and deploying difficult airway equipment carts throughout the hospital. The safety component focused on real-time monitoring of DART activations and learning from past DART events to continuously improve system-level performance. This objective entailed monitoring the paging system, reporting difficult airway events and DART activations to a Web-based registry, and using in situ simulations to identify and mitigate defects in the emergency airway management process. The educational component included development of a multispecialty difficult airway curriculum encompassing case-based lectures, simulation, and team building/communication to ensure consistency of care. Educational materials were also developed for non-DART staff and patients to inform them about the needs of patients with difficult airways and ensure continuity of care with other providers after discharge. RESULTS: Between July 2008 and June 2013, DART managed 360 adult difficult airway events comprising 8% of all code activations. Predisposing patient factors included body mass index >40, history of head and neck tumor, prior difficult intubation, cervical spine injury, airway edema, airway bleeding, and previous or current tracheostomy. Twenty-three patients (6%) required emergent surgical airways. Sixty-two patients (17%) were stabilized and transported to the operating room for definitive airway management. There were no airway management-related deaths, sentinel events, or malpractice claims in adult patients managed by DART. Five in situ simulations conducted in the first program year improved DART's teamwork, communication, and response times and increased the functionality of the difficult airway carts. Over the 5-year period, we conducted 18 airway courses, through which >200 providers were trained. CONCLUSIONS: DART is a comprehensive program for improving difficult airway management. Future studies will examine the comparative effectiveness of the DART program and evaluate how DART has impacted patient outcomes, operational efficiency, and costs of care.

AB - BACKGROUND: Difficult airway cases can quickly become emergencies, increasing the risk of life-threatening complications or death. Emergency airway management outside the operating room is particularly challenging. METHODS: We developed a quality improvement program - the Difficult Airway Response Team (DART) - to improve emergency airway management outside the operating room. DART was implemented by a team of anesthesiologists, otolaryngologists, trauma surgeons, emergency medicine physicians, and risk managers in 2005 at The Johns Hopkins Hospital in Baltimore, Maryland. The DART program had 3 core components: operations, safety, and education. The operations component focused on developing a multidisciplinary difficult airway response team, standardizing the emergency response process, and deploying difficult airway equipment carts throughout the hospital. The safety component focused on real-time monitoring of DART activations and learning from past DART events to continuously improve system-level performance. This objective entailed monitoring the paging system, reporting difficult airway events and DART activations to a Web-based registry, and using in situ simulations to identify and mitigate defects in the emergency airway management process. The educational component included development of a multispecialty difficult airway curriculum encompassing case-based lectures, simulation, and team building/communication to ensure consistency of care. Educational materials were also developed for non-DART staff and patients to inform them about the needs of patients with difficult airways and ensure continuity of care with other providers after discharge. RESULTS: Between July 2008 and June 2013, DART managed 360 adult difficult airway events comprising 8% of all code activations. Predisposing patient factors included body mass index >40, history of head and neck tumor, prior difficult intubation, cervical spine injury, airway edema, airway bleeding, and previous or current tracheostomy. Twenty-three patients (6%) required emergent surgical airways. Sixty-two patients (17%) were stabilized and transported to the operating room for definitive airway management. There were no airway management-related deaths, sentinel events, or malpractice claims in adult patients managed by DART. Five in situ simulations conducted in the first program year improved DART's teamwork, communication, and response times and increased the functionality of the difficult airway carts. Over the 5-year period, we conducted 18 airway courses, through which >200 providers were trained. CONCLUSIONS: DART is a comprehensive program for improving difficult airway management. Future studies will examine the comparative effectiveness of the DART program and evaluate how DART has impacted patient outcomes, operational efficiency, and costs of care.

UR - http://www.scopus.com/inward/record.url?scp=84942859409&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84942859409&partnerID=8YFLogxK

U2 - 10.1213/ANE.0000000000000691

DO - 10.1213/ANE.0000000000000691

M3 - Article

C2 - 26086513

AN - SCOPUS:84942859409

VL - 121

SP - 127

EP - 139

JO - Anesthesia and Analgesia

JF - Anesthesia and Analgesia

SN - 0003-2999

IS - 1

ER -