Introduction: Emergency airway management of critically ill children in the Emergency Department (ED) is associated with the risk of intubation-related desaturation, which can be minimized by apneic oxygenation. We evaluated the use of apneic oxygenation in the pediatric ED and reported a quality improvement initiative to incorporate apneic oxygenation as a routine standard of care during rapid sequence intubations (RSIs). Methods: A baseline period from June 2016 to April 2017 highlighted the practice gaps. Quality improvement interventions were subsequently developed and implemented as a care bundle consisting of a pre-intubation checklist, placing reminders and additional oxygen source in resuscitation bays, incorporating into the responsibilities of the airway doctor and the airway nurse (copiloting), education during airway workshops and simulation training for doctors and nurses, as well as enhancing documentation of the intubation process. We monitored a post-intervention observation period from May 2017 to April 2018 for the effectiveness of the care bundle. Results: Apneic oxygenation was not performed in all 22 RSIs during the baseline period. Among 25 RSIs in the post-intervention observation period, providers performed apneic oxygenation in 17 (68%) cases. There was no significant difference in the utilization of apneic oxygenation among emergency physicians and pediatric anesthetists performing RSIs in the pediatric ED. Conclusions: We successfully implemented a care bundle targeted at incorporating apneic oxygenation as a routine standard of care during emergency intubations performed in ED. This method could be adopted by other pediatric EDs to improve airway management in critically ill children.

Background: Effective communication is of paramount importance in delivering patient-centred care. Effective communication between the healthcare personnel and the patient leads to better compliance, better health outcomes, decreased litigation, and higher satisfaction for both doctors and patients. Objective: The objective of the study was to evaluate the effectiveness of a comprehensive blended communication program to improve the communication skills and the confidence level of all staff of a department of emergency medicine in Singapore in dealing with challenging communication situations. Methods: All doctors and nurses working in the selected Children’s Emergency Department (ED) attended blended teaching to improve communication skills. Qualitative feedback was gathered from participants via feedback forms and focus group interviews. Communication-related negative feedback in the ED was monitored over a period of 18 months, from 1st July 2017 to 31st December 2018. Results: Immediately after the course, 95% of the participants felt that they were able to better frame their communications. Focus group interviews revealed four main themes: (A) Increased empowerment of staff; (B) Improved focus of communication with parents; (C) Reduced feeling of incompetence when dealing with difficult parents and; (D) Increased understanding of main issues and parental needs. There was 81.8% reduction in communication-related negative feedback received in the ED monthly after the workshop had been carried out (95% confidence interval 0.523, 0.8182). Conclusion: A comprehensive blended communication workshop resulted in a perceived improvement of communication skills among the healthcare personnel and significantly decreased the communication-related negative feedback in a pediatric ED.