Education, Research, and Quality Improvement: Education and Quality Improvement |

Code Airway: Not a Rescue Event FREE TO VIEW

Patricia McCabe, MSN; George Sample, MD; Emily Rhoades, ACNP; Thorne Janet, RN
Author and Funding Information

MedStar Washington Hospital Center, Fairfax, VA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A239. doi:10.1016/j.chest.2016.02.248
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SESSION TITLE: Education and Quality Improvement

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM

PURPOSE: The purpose of this poster is to highlight cases where proactively calling a Code Critical Airway resulted in an established, patent airway, without waiting for patient deterioration, thus improving patient outcome and safety.

METHODS: The poster was developed by performing retroactive reviews of charts, an in depth review of each Code Critical Airway call as well as peer review post event to determine process opportunities.

RESULTS: During calendar year 2014, there were fifty eight Code Critical Airways called at Medstar Washington Hospital Center. Of those 58 patients, forty eight were discharged alive. One patient’s disposition is unknown. Of the nine patients that did not survive to discharge, three died during the Code Critical Airway. Of those 3 patients that died, two were Code Blue’s (cardiac arrest occurred prior to the Code Critical Airway call) in progress and it was determined that establishing an adequate airway did not contribute to their death. Also, of the fifty eight patients, none were previously known to have a difficult airway. From analysis of past CA’s, we have mandated that “difficult airway” be entered as part of the patient’s electronic medical record. This electronic visual alert affords practitioners and providers the benefit of anticipating a difficult intubation where the airway team can be called proactively and be available for airway management. In the past six years we have seen a decrease the mortality rate of code airway patients.

CONCLUSIONS: By establishing a culture that encourages the use of an established Code Critical Airway system to proactively call for help establishing a patent airway, patient outcomes can be improved. By calling a multidisciplinary team together to manage an actual or suspected difficult airway before a patient is in distress, the process becomes one of intervention instead of a rescue operation. Utilizing the electronic medical record to provide practitioners and providers advance notice of possible airway issues allows them to proactively call Code Critical Airway team members who are then readily available to secure an airway.

CLINICAL IMPLICATIONS: These findings suggest that, when used proactively, a Code Critical Airway can change an event from a rescue operation to a controlled, interventional event that has better patient outcomes.

DISCLOSURE: The following authors have nothing to disclose: Patricia McCabe, George Sample, Emily Rhoades, Thorne Janet

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