Endotracheal Excellence: Standardizing Documentation to Drive Quality in Airway Rescue Procedures Across the Health System.

Background Out-of-operating-room airway management is a time-sensitive, life-saving procedure performed in many clinical units in acute care hospitals. Local airway management practice should be understood and monitored to identify opportunities for quality improvement. Objectives As a first step to drive excellence in advanced airway practice across our three-hospital health system, we sought to establish documentation standards for emergency airway procedures. Methods Representatives in advanced airway practice (emergency medicine, anesthesia, critical care, otolaryngology, respiratory therapy) and clinical informatics investigated current institutional airway procedure documentation and national best practices. We developed a high-reliability note template based on the electronic health record (EHR) to document the details of an airway event and support participation in national emergency airway registries. It was designed and implemented using in situ simulation with high-utilizer groups. Simulation and one-on-one end-user feedback gathered through interviews and surveys informed subsequent iterations. The new note template capitalized on existing emergency department (ED) workflows, so it was launched first in EDs across the health system. Using a similar implementation plan and through collaboration with relevant stakeholders, the note was adapted for unit-specific performance. Results The note is used as standard practice in EDs, delivery rooms, neonatal and pediatric intensive care units (ICUs), and is available for all hospital-based providers in the health system. The note has been used in over 3,000 patient encounters. Note data is available on demand, an important resource that drives both continuous performance improvement efforts and efficiency for national registry participation. The information contained within the note drives various quality improvement and safety initiatives that reach patients. Conclusion Standardizing documentation for airway procedures using shared electronic data elements in the EHR is important as it provides a discrete data stream for capturing our current practice, performance outcomes, opportunities, and vulnerabilities.