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Unplanned extubation (UE) occurs in 0-25 % of patients intubated in the prehospital setting and transfer of patient care is one time where UE can occur. This EMS jurisdiction wanted to improve the rate of communication and confirmation of tube placement at the time of patient transfer. Over 5 months, the jurisdiction introduced 1) memorandums to paramedics, ED chiefs and respiratory therapist leads, 2) individualized paramedic feedback emails and 3) PCR changes that resulted in documentation of tube placement at transfer of care being a mandatory field.
Initially the rate of verbal ETT position at transfer of care was 74%. This increased to > 90% after 8 weeks. The rate of UE was 2/340 patients. The implementation of this project showed improvements in perceived accountability, interprofessional relationships and satisfaction with interventions that were noted in the post project focus group.
References
Kwong JL, Bourn S, Hillier M, et al. A Quality Improvement Initiative to Increase Confirmation of Prehospital Endotracheal Tube Placement at Emergency Department Transfer of Care. Prehosp Emerg Care. Published online June 20, 2024. doi:10.1080/10903127.2024.2366401