Compliance and Attitudes of Critical Care Transport Providers Regarding a Prehospital Rapid Sequence Intubation Checklist

Abstract

Listen

Translate article

<h3>Background</h3> Checklists have been adopted in various acute care settings with reasonable compliance and acceptance. In the Air Medical industry, checklists have been implemented by different teams for critical clinical procedures such as rapid sequence intubation (RSI). However, compliance and attitudes toward these Human Factors innovations in the critical care transport setting are not well-described. <h3>Methods</h3> We conducted an IRB-exempt, retrospective review of checklist usage to assess compliance with a required RSI checklist by critical care transport providers. We also conducted an IRB-exempt survey of critical care transport providers with 5 questions based on Rogers' theory of diffusion of innovation that had graded responses on a 1-5 Likert scale. The distribution of responses for each question was determined and summarized using means and standard deviations. A free-marginal Kappa along with 95% confidence interval was determined to measure inter-rater consistency. <h3>Results</h3> Checklist compliance was 92% over the period reviewed after checklist implementation. There was a 10% response to the survey questions and a total of 314 individual responses were recorded. Questions regarding compatibility with practice and difficulty of use were favorable. The response to how the checklist flows with current RSI performance was 4.07 (SD 1.060). The average response to the questions regarding difficulty of learning the list and teaching the list were 4.53 (SD 0.861) and 4.10 (SD 1.056) respectively. But, with questions regarding observable change to practice, there was slight difference. The response to the question regarding the checklist effect on reduction of cognitive load was less strong at 3.74 (SD 1.290). Crew members, however, did believe that helped make sure they did not miss anything during the RSI procedure with an average response of 4.10 (SD 1.125) <h3>Conclusions</h3> Process compliance with checklist implementation was excellent. Most respondents felt that the innovation of using the checklist fit well into their existing practice and was not difficult to learn or teach. The majority of respondents also felt it was helpful at preventing procedural errors.