One of the most pervasive aspects of American health care in today’s environment is the drive to maintain and improve high quality health care while reducing the costs of that care. Health care costs account for approximately 16% of the gross domestic product, triple the amount from the previous five years. Anesthesia providers are constantly urged to include cost consciouness in their decisions, balancing the natural desire to provide the highest quality of care with the overall priorities of both the health care system and the individual patient. Anesthesia professionals remain targets for limiting health care expenditures. This fact is due in part to anesthesia professionals, directly and indirectly, accounting for 3 to 5% of the total health care costs in this country. Airway management is the cornerstone of anesthesia practice. The proper management of the airway, including the ability to intubate the trachea, is paramount. In 1993, the American Society of Anesthesiologists (ASA) identified the need for improved strategies to manage the patient’s airway. This led to the development and implementation of clinical practice guidelines (CPG) for the management of the difficult aiway. These CPGs provide a systematic approach to airway management using algorithm charts. Within these practice guidelines, several alternative devices or adjuncts are identified to assist with intubation. Many of these adjuncts have been used for years and have documented favorable patient care related outcomes. The long term goal of this project was to implement a practice change to influence care at the point of patient contact. The short term goal of this project was to put into practice an evidence-based practice (EBP) intervention to facilitate the use of the ASA CPG for the management of the difficult airwat by CRNSs. The outcomes improved cost efficiency, decreased traumatic intubations, and improved access to affordable care by incorpoprating the CPGs into their practice. The objectives of the practice change were to facilitate the use of the CPG by decreasing their knowledge deficit regarding the Bougie. The construction and implementation of the EBP change followed the steps discussed in The Model for Evidence-based Practice Change. Pre intervention and post intervention data was gathered for 3 months. By decreasing CRNAs knowledge deficit through the EBP intervention and outcome indicators were all favorable. The quantitative analysis and target outcomes of the intervention demonstrated that the intervention was highly effective. CRNAs increased the use of the Bougie 533% which improved cost efficiency. The decrease in traumatic intubations was also decreased by 100%. Access to affordable care was demonstrated with the 533% increase in usage of the Bougie. Collectively, the favorable outcomes confirmed that the overall quality of care was improved. This data was gathered from a quality assurance data collection tool which identified the airway adjunct and adverse events during difficult airway management. The Bougie is now the most commonly used airway adjunct at the sponsoring facility. This EBP educational intervention was effective and facilitated the use of the CPG which increased the use of the Bougie at the point of care.
