@article {McConnell902, author = {Ryan A McConnell and Meeta Prasad Kerlin and William D Schweickert and Faraz Ahmad and Mitesh S Patel and Barry D Fuchs}, title = {Using a Post-Intubation Checklist and Time Out to Expedite Mechanical Ventilation Monitoring: Observational Study of a Quality Improvement Intervention}, volume = {61}, number = {7}, pages = {902--912}, year = {2016}, doi = {10.4187/respcare.04191}, publisher = {Respiratory Care}, abstract = {BACKGROUND: Delayed mechanical ventilation monitoring may impede recognition of life-threatening acidemia. Coordination of multidisciplinary processes can be improved by using a checklist and time-out procedure. The study objective was to evaluate process-related outcomes after implementation of a post-intubation checklist and time out.METHODS: An observational study of a 24-bed medical ICU in Philadelphia, Pennsylvania, was conducted from January to December 2011. A random sample of mechanically ventilated adults was selected from the pre-intervention (n = 80) and post-intervention (n = 144) periods. The primary outcome was the proportion of subjects with an arterial blood gas (ABG) result within 60 min of mechanical ventilation initiation. Secondary outcomes included rates of respiratory acidosis, moderate-severe acidemia (pH \<7.25), checklist initiation, and project sustainability. Chi-square analysis was used to evaluate differences in outcomes between time periods.RESULTS: After the intervention, the proportion of subjects with an ABG result within 60 min increased (56\% vs 37\%, P = .01), and time to ABG result improved (58 min vs 79 min, P = .004). Adjusting for illness severity, the proportion with an ABG result within 60 min remained significantly higher in the post-intervention period (odds ratio 2.42, 95\% CI 1.25{\textendash}4.68, P = .009). Checklist adherence was higher with ICU intubations than for intubations performed outside the ICU (71\% vs 27\% checklist initiation rate, P \< .001). Transfer from referring institutions (23\% checklist initiation rate, P = .006) negatively impacted checklist use. Implementation challenges included frequent stakeholder turnover, undefined process ownership, and lack of real-time performance feedback.CONCLUSIONS: A post-intubation checklist and time out improved the timeliness of mechanical ventilation monitoring through more rapid assessment of arterial blood gases. Implementing this peri-intubation procedure may reduce the risks associated with transitioning to full mechanical ventilatory support. Optimal implementation necessitates strategies to surmount organizational and behavioral barriers to change.}, issn = {0020-1324}, URL = {https://rc.rcjournal.com/content/61/7/902}, eprint = {https://rc.rcjournal.com/content/61/7/902.full.pdf}, journal = {Respiratory Care} }