Background: Bedside procedures are seldom subject to the same safety precautions as operating room (OR) procedures. Since July 2013, we have performed a multidisciplinary checklist before all bedside bronchoscopy-guided percutaneous tracheostomy insertions (BPTIs). We hypothesized that the implementation of this checklist before BPTI would decrease adverse procedural events.
Methods: A prospective study of all patients who underwent BPTI after checklist implementation (PostCL, 2013-2014, n = 63) at our Level I trauma center were compared to all patients (retrospectively reviewed historical controls) who underwent BPTI without the checklist (PreCL, 2010-2013, n = 184). Exclusion criteria included age less than 16 years, OR, and open tracheostomy. The checklist included both a procedural and timeout component with the trauma technician, respiratory therapist, nurse, and surgeon. Demographics and variables focusing on BPTI risk factors were compared. Variables associated with the primary end point, adverse procedural events, during univariate analysis were used in the multiple variable logistic regression model. A p ≤ 0.05 was significant.
Results: Of 247 study sample patients, no difference existed in body mass index, baseline mean arterial pressure, duration or mode of mechanical ventilation, cervical spine or maxillofacial injury, or previous neck surgery between PreCL and PostCL BPTI patients. PreCL patients were younger (48 [20] years vs. 57 [21] years, p < 0.01) but more often had adverse procedural events compared with PostCL patients (PreCL,14.1% vs. PostCL,3.2%, p = 0.020). After adjusting for age, vitals, BPTI risk factors, and intensive care unit duration after BPTI, multiple variable logistic regression determined that performing the safety checklist alone was independently associated with a 580% reduction in adverse procedural events (odds ratio, 5.8; p = 0.022).
Conclusion: Our results suggest that the implementation of a multidisciplinary safety checklist similar to those used in the OR would benefit patients during invasive bedside procedures.
Level of evidence: Therapeutic/care management study, level IV.