Authors: (including presenting author): :
Man CHM(1), Lam CHH(1), Chan CSS(1), Tse KYG(1), Yu SYJ(1), Yeung WTA(1)
Affiliation: :
(1)Intensive Care Unit, Department of Medicine & Geriatrics, Ruttonjee & Tang Shiu Kin Hospitals
Keyword 1: :
Rapid Sequence Intubation
Keyword 4: :
Airway Management
Keyword 5: :
Patient Safety
Keyword 6: :
Standardized Workflow
Introduction: :
Endotracheal intubation is a high-risk, time-critical procedure in the intensive care unit (ICU), requiring precise coordination among multidisciplinary team members. Although intubation is commonly performed, there was no standardized intubation drill in our ICU. Variations in airway preparation, medication sequencing, and role delineation may therefore occur during real-life emergencies, potentially impacting patient safety. Simulation-based training is an effective strategy for improving performance in high-risk clinical procedures by enhancing technical skills, communication, and situational awareness, while allowing latent system risks to be identified in a safe learning environment. A structured ICU intubation drill was implemented to standardize rapid sequence intubation (RSI) workflow and enhance interdisciplinary teamwork.
Objectives: :
This project aimed to evaluate the effectiveness of a structured ICU intubation drill in:
1.Enhancing interdisciplinary communication and role clarity
2.Assessing adherence to a standardized RSI workflow using the Preparation, Preoxygenation, Pretreatment, Paralysis with Induction, Protection and Positioning, Placement, Post-intubation Management’ (7Ps) framework
3.Identifying system gaps and formulating targeted improvement measures to enhance patient safety
Methodology: :
A multidisciplinary simulation-based intubation drill was conducted in ICU in October 2025. The scenario involved a hypoxemic dummy patient with severe pneumonia requiring RSI. Participants included ICU physicians and nurses assuming designated roles (junior physicians, nurse-in-charge, ventilator nurse, and medication nurse). Performance was assessed using a structured RSI checklist covering 7Ps framework. Participants were debriefed to identify strengths, areas for improvement, and system gaps.
Result & Outcome: :
During the initial intubation drill, direct observation of participants’ performance identified gaps in both technical skills and interdisciplinary teamwork. Variability was observed in role delineation, task sequencing, closed-loop communication, and coordination during medication preparation, ventilator setup, and post-intubation management. Objective assessment using a standardized RSI checklist demonstrated an overall compliance rate of 82% during the drill, indicating areas for improvement in standardized airway management and team performance. Following structured debriefing, targeted reinforcement of the standardized RSI workflow, and subsequent follow-up practice, participants’ performance showed marked improvement. Repeat observation demonstrated enhanced technical execution and interdisciplinary coordination, with clearer role allocation, more consistent closed-loop communication, and smoother task integration between physicians and nurses. The overall compliance rate improved to 98%, reflecting substantial improvement in both technical skills and teamwork performance. Post-simulation feedback further supported these findings, with a staff satisfaction rate of 98% and the majority of participants reporting improved confidence, role clarity, and situational awareness during intubation. The simulation also identified system gaps for future improvement, particularly in a ‘speak-out’ culture in medication clarification, dynamic role back-up during airway tasks, and standardization of contingency airway preparedness. These findings were translated into targeted improvement measures and reinforced through structured debriefing by intensivists and senior nurses, with key learning points disseminated internally to all ICU nursing and medical staff to facilitate knowledge sharing through a post-drill report.
