Application of the PDCA Cycle Management in Quality Improvement of Endotracheal intubation in Emergency Department among Standardised Training Residents

Purpose: This study aimed to improve the first pass success (FPS) rate of endotracheal intubation (ETI) performed by residency physicians in the emergency department using the PDCA cycle management approach. It also sought to increase the difficult airway identification success rate while reducing the multiple-attempts rate and overall complications. Methods: We compared data collected before (January 2021 - December 2022, control group, n=36) and after (January 2023 - December 2023, experimental group, n=44) implementing the PDCA cycle. The PDCA plan included: Plan: Set goals for standardized operations, skill advancement, and refined complication prevention; establish key indicators including FPS rate, multiple-attempts rate, difficult airway identification success rate, and overall complication rate. Do: Implement a tiered training system (admission system + graded practice), standardized operating procedures (SOP), and comprehensive quality control (use of video laryngoscopy, difficult airway protocols). Check: Monitor how well the procedures were followed in real-time (completeness of steps, correctness of equipment use). Act: Keep improving training based on feedback from the data. Results: Compared to before PDCA implementation, the FPS rate of the experimental group increased significantly from 55.6% (control group, 20/36) to 86.4% (38/44) ( P <0.01). The rate of complications included esophageal intubation (6.8% vs. 27.8%) and laryngeal edema/vocal cord injury (4.5% vs. 30.5%), both of which decreased significantly compared to the control group, which was statistically significant ( P <0.01). The ifficult airway identification success rate between these two groups were 30.8% and 92.9%, respectively, with statistical significance ( P <0.01). Results by experience level showed that the FPS rate for third-year STRs increased from 50.0% to 85.2%, while the FPS rate for second-year STRs increased from 62.5% to 88.2%. Conclusion: The PDCA cycle management significantly improves the FPS rate of ETI and enhances operational safety through a tiered training system, standardized procedures, and dynamic quality control.. This approach provides a repeatable training framework for developing technical talent in emergency medicine and plays a vital role in managing airways of critically ill patients.