The PIMS approach to airway access.

Abstract

BACKGROUND: ICU intubation may be difficult for both anatomical and physiological reasons and hence intubation approaches encompassing both these considerations are desirable. This study assessed the implementation of a standardized airway trolley and checklist in the format Physiology, Instrumentation, Monitoring and Staffing (PIMS). AIM: To investigate the effect of an integrated intensive care unit (ICU) airway trolley and checklist on the adequacy of preparation for endotracheal intubation. METHODS: Single-centre, before and after observational study of ICU doctors and nurses. Baseline performance in preparing for intubation was assessed by in-situ simulation. Performances were reassessed using in-situ simulation 2 weeks and 3 months post PIMS implementation. Preparation was timed and scored out of 51 according to a predetermined checklist of the optimal requirements for intubation preparation. RESULTS: There were 47 participants (11 doctors and 36 nurses). 46 participants were reassessed at 2-weeks and 37 at 3-months. Mean (SD) baseline scores were 10.9 (5.8). At 2 weeks the mean score increased by 31.8 (7.3) p<0.001 and at 3 months by 28.4 (8.4), p<0.001. Mean preparation time at baseline was 347 (122) seconds, increasing by 47s (2 weeks) and 11s (3 months). 18/47 (38%) of participants took greater than 1 minute to retrieve emergency drugs or equipment at baseline compared to 0% at 2 weeks and 3 months, p<0.001. CONCLUSION: The PIMS approach resulted in significant, sustained improvement in preparation for intubation and elimination of dangerous delays in retrieving drugs and equipment. This simple intervention added less than 1 minute to preparation times.