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A standardised approach to pre-hospital RSI in the UK; utility, governance and content of current pre-induction checklists
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine volume 23, Article number: A16 (2015)
Background
Pre-hospital Rapid Sequence Induction (RSI) is often performed on patients nearing physiological exhaustion in a complex, challenging environment [1]. Standard Operating Procedures (SOPs) and checklists can be used to improve patient safety [2]. The UK incidence of pre-hospital RSI and the utility and content of these safety constructs are unknown.
Methods
A piloted survey was sent to the lead clinicians for all UK pre-hospital services with potential to be able to deliver RSI. Data was compared for high volume (>50 RSIs per annum) and low volume (≤50 RSIs per annum). Another piloted survey was sent to UK clinicians who themselves perform pre-hospital RSI. Current pre-induction checklists were compared and contrasted in terms of length, content and format.
Results
58 individual services were identified with 76.8% responding. 69.8% of services have RSI capabilities, 26.7% of which throughout a 24-hour period. 1564 RSIs are performed per annum.
SOPs for RSI are used by 80% and checklists by 76.8% of services, (> commonly in high volume services). 40% of these teams have a separate ‘crash-induction’ checklist. Review and revision of checklist content with involvement of clinicians is more common in high volume Vs. low volume services. The majority of all clinicians surveyed responded that they both prefer a standardized approach to RSI and that it is safer than allowing absolute autonomy.
There was a large variation in length, content, style and format between the checklists analysed.
Discussion
Despite the availability of pre-hospital RSI being sporadic, it is performed commonly in the UK. SOPs and safety checklists are used more commonly by high volume teams. In the challenging setting of pre-hospital care, these safety constructs may liberate spare bandwidth for utilization on other tasks, although care must be taken to limit the length and simplify the language as much as possible.
References
Perkins ZB, Wittenberg MD, Nevin D, et al: The relationship between head injury severity and haemodynamic response to tracheal intubation. The Journal of Trauma. 2013, 74 (4): 1074-1080. 10.1097/TA.0b013e3182827305.
Rognas L, Hansen TM, et al: Standard operating procedure changed pre-hospital critical care anaesthesiologists’ behaviour: a quality control study. Scand J Trauma Resusc Emerg Med. 2013, 21: 84-10.1186/1757-7241-21-84.
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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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Burgess, M.R., Perkins, Z. A standardised approach to pre-hospital RSI in the UK; utility, governance and content of current pre-induction checklists. Scand J Trauma Resusc Emerg Med 23, A16 (2015). https://doi.org/10.1186/1757-7241-23-S2-A16
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DOI: https://doi.org/10.1186/1757-7241-23-S2-A16
Keywords
- High Volume
- Standard Operating Procedure
- Challenging Environment
- Improve Patient Safety
- Individual Service