Table 1 Verdict of expert panel on items for inclusion as TVAA PHEA KPI
Comments | Suggested inclusion on TVAA PHEA KPI | |
|---|---|---|
AAGBI Suggested KPI | ||
Use of SOP and checklist | Standard for all PHEA at TVAA | |
All team familiar with failed intubation plans | Difficult to measure | |
Daily equipment check performed | Data not retrievable from EPR | |
Full monitoring including capnography | Zoll monitor links directly to EPR allowing easy review of these figures | Yes |
Pre-oxygenation for 3 mins | Difficult to measure | |
Intubation by experienced airway provider | All those providing PHEA at TVAA should be “experienced” as they will be either consultants or a minimum of ST4 in either Emergency Medicine or Anaesthesia | |
No decrease of more than 20% in SBP | Zoll monitor links directly to EPR allowing easy review of these figures | Yes |
No decrease in Sa0 2 below 90% or fall of > 10% below starting value | Zoll monitor links directly to EPR allowing easy review of these figures | Yes |
No more than 2 attempts before success | The ‘RSI’ tab on the EPR includes this data, therefore easily measureable | Yes |
Position of tube maintained and confirmed with capnography | Easily measured as Zoll monitor links directly to EPR | Yes |
Adequate anaesthesia maintained | Difficult to define but TVAA SOPs suggest a continuous infusion of sedative via an infusion pump at a rate suitable for the patient | Yes |
Cardiovascular stability maintained | Zoll monitor links directly to EPR allowing easy review of these figures | Yes |
Ventilation titrated to ETCO 2 | Difficult to measure | |
Other KPIs that were considered | ||
PHEA within 45 min of call | NICE standard for trauma. Also recommended in ref. 1 | Yes |
Indication for PHEA documented | The “RSI” tab on the EPR includes this data, therefore easily measureable Also recommended in ref. 1. | Yes |
Grade of view | Cormack Lehane grade of view should be < 3. Consensus opinion by expert group to detect patterns potentially due to poor intubating technique. | Yes |