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Quality Improvement Program Outcomes for Endotracheal Intubation in the Emergency Department

Hwang, Sung Yeon, MD, PhD*; Park, Joo Hyun, MD*; Yoon, Hee, MD, MS*; Cha, Won Chul, MD, PhD*; Jo, Ik Joon, MD, PhD*; Sim, Min Seob, MD, PhD*; Song, Keun Jeong, MD, PhD*; Woo, Hyo Jung, RN, MS; Jeong, Sung Geun, RN, MS; Shin, Tae Gun, MD, PhD* Samsung Medical Center Emergency Airway Management Team

doi: 10.1097/PTS.0000000000000536
Original Articles

Objectives We describe our 3-year experience with endotracheal intubation (ETI) outcomes during a multidisciplinary emergency department (ED)-based quality improvement (QI) program.

Methods This was a single-center, observational study taking place during a QI program. We used a registry for airway management performed in the ED from April 2014 to February 2017. The QI program focused on procedural standardization, airway management education, and comprehensive preparation of airway equipment. The primary outcome was first-pass success (FPS) rate. The secondary outcomes were multiple-attempts rate and overall rate of complications.

Results A total of 1087 emergent ETIs were included. The FPS rate significantly increased from 68% in the first year to 74% in the second year and 79% in the third year (P for trend <0.01). The multiple-attempts rate in the first year was 12%, followed by 7% and 6% in the second and third years, respectively (P for trend <0.01). The overall complication rate was 16% in the first year, 8% in the second year, and 8% in the third year (P for trend <0.01).

Conclusions We observed improved ETI outcomes in the ED, including increased FPS rate and decrease in multiple-attempt rate and overall complication rate during the multidisciplinary QI program to enhance patient safety.

From the *Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine; and

Department of Emergency Nursing, Samsung Medical Center, Seoul, South Korea.

Correspondence: Tae Gun Shin, MD, PhD, Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea (e-mail:;

The authors disclose no conflict of interest.

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