“Correctly placing and securing a breathing tube for a patient and performing an intubation is one of the riskiest procedures in healthcare.” – Drew Fuller, MD, CPPS, MPH, FACEP, RRT
Airway procedures take place in various settings including, pre- hospital emergency medical services (EMS), emergency departments (ED), operating rooms (OR), intensive care units (ICU), general medical and surgical units, procedural areas and outpatient settings.
Despite the many settings airways are placed, airway-related injuries remain almost entirely preventable.
Airway adverse events caused by delayed, missed, or lost airways, aren’t something you read about every day, yet harm and catastrophic injuries that result from airway events, including death, can take place in 1 in every 100 intubations. Some clinical areas have shown an even higher risk for injury, for example, patients requiring intubation in ED or ICU settings are 40 to 60 times more likely to suffer brain injuries or die because of a failed airway when compared to the OR. And it’s almost always avoidable.
Dr. Drew Fuller, emergency physician and national leader for safety solution development, works with a team of clinicians and safety experts and has identified the answer to airway safety. The answer relies on bringing high impact airway safety practices together in a comprehensive way and standardizing these practices across systems. Fuller and team developed a bundle that can be used by any hospital or department, regardless of their size. A bundle that includes a universal set of high reliability solutions that can help remedy the devastating and avoidable outcomes of airway adverse events.
“No matter how much good “piecemeal” information there is or what thought leaders are advancing, most hospitals have yet to implement systems to assure that best practices are common practices. We need standardized, team-based, system solutions throughout the continuum of care,” Fuller said.
Like most doctors, Fuller’s career evolved through various professional roles. 30 years ago, he started his career as a Respiratory Therapist, and through this role met many mentors who encouraged him to go to medical school. Fuller started with primary care and emergency medicine at Johns Hopkins health System and developed his passion for safety after meeting Peter Pronovost. Hyper attention to system vulnerability and safety became Dr. Fuller’s life. He saw how important his role was in patient safety, especially as an emergency physician. Fuller now serves as Chief Safety Officer for Emergency Medicine Associates, the largest provider of emergency care services in the Mid-Atlantic.
Dr. Fuller and Jon D’Souza, MD, MBA , worked with EMA’s Safety Leadership Group and national safety experts to develop an airway safety bundle to help standardize high reliability practices in the ED and ICU settings. They studied best practices from the Difficult Airway Society, the VA Medical System and other airway experts and worked to develop a comprehensive toolkit to help hospitals implement key best practices.
Starting with several regional hospitals, Dr. Fuller and his team studied barriers and identified the most common elements that could help address major vulnerabilities with airway management. Their research showed that missing essential elements included a lack of the following key components: failed airway protocols, comprehensive airway carts/ equipment, QA systems (checklist) and team-based practices. Their response was to create a toolkit with solutions that could reasonably be standardized and customized to meet any hospital setting. The early open access toolkit is located at www.SaferAirway.org.
The Patient Safety Movement Foundation Airway Safety workgroup has developed recommendations that support and advance the Safer Airway toolkit.
Healthcare system standards aren’t as strong as they should and need to be. It’s not that healthcare practitioners require more training and education, it’s that more system resources are necessary. One example, Fuller reports, is team-based training.
“It’s surprising to think there is no clear or formal team-based approach for intubation. Proper training of equipment and airway safety protocols are oftentimes neglected by the healthcare system. When faced with a severe airway adverse incident, staff are left in a state of panic which decreases their efficiency and effectiveness,” Fuller said.
Fuller’s aim is to help hospitals implement practical, team-based safety solutions with tools that can work in any department or hospital.
“You would think there was a universal standard. We have this functional blindness that what we have in place is good. We too often rely on hope, and hope is a terrible strategy for safety.”
If the systems aren’t hardwired with standard airway protocols (formal, efficient next steps for rescue
of a failed airway) collaborative team practices or comprehensive carts/ rescue equipment, and QA tools, then errors are bound to perpetuate.
“There is a distinction between system excellence and individual excellence. We cannot rely only on one single doctor to perform outstanding intubations. We need clear team-based, high-impact, system solutions that can be used in any setting from smaller, critical access hospitals to large academic medical centers.”
Fuller leads the development of Safer Airway, a national resource for the advancement of airway safety in U.S. hospitals as well as the Emergency Medicine Associate’s Safety Leadership Group that developed the industry acclaimed Safer Sign Out Toolkit.