A Preprocedural Checklist Improves the Safety of Emergency Department Intubation of Trauma Patients

OBJECTIVES: Endotracheal intubation of trauma patients is a vital and high-risk procedure in the emergency department (ED). The hypothesis was that implementation of a standardized, preprocedural checklist would improve the safety of this procedure. METHODS: A preprocedural intubation checklist was developed and then implemented in a prospective pre-/postinterventional study in an academic trauma center ED. The proportions of trauma patients older than 16 years who experienced intubation-related complications during the 6 months before checklist implementation and 6 months after implementation were compared. Intubation-related complications included oxygen desaturation, emesis, esophageal intubation, hypotension, and cardiac arrest. Additional outcomes included time from paralysis to intubation and adherence to safety process measures. RESULTS: During the study, 141 trauma patients were intubated, including 76 in the prechecklist period and 65 in the postchecklist period. A lower proportion of patients experienced intubation-related complications in the postchecklist period (1.5%) than the prechecklist period (9.2%), representing a 7.7% (95% confidence interval = 0.5% to 14.8%) absolute risk reduction. Paralysis-to-intubation time was also lower in the postchecklist period (median = 82 seconds, interquartile range IQR = 68 to 101 seconds) compared to the prechecklist period (median = 94 seconds, IQR = 78 to 115 seconds; p = 0.02). Adherence to safety process measures also improved, with all safety measures performed in 69.2% in the postchecklist period compared to 17.1% before the checklist (p < 0.01). CONCLUSIONS: Implementation of a preintubation checklist for ED intubation of trauma patients was associated with a reduction in intubation-related complications, decreased paralysis-to-intubation time, and improved adherence to recognized safety measures.