Adoption of video laryngoscopy in Massachusetts emergency departments

Abstract

Background: Previous research suggests that video laryngoscopy may be superior to direct laryngoscopy.

Objectives: We sought to determine the proportion of Massachusetts emergency departments (EDs) that have adopted video laryngoscopy, the characteristics of user and non-user EDs, the reasons why non-users do not use video laryngoscopy, and how the adoption of video laryngoscopy compares to typical technology adoption life cycles.

Methods: Surveys were mailed to directors of all non-federal EDs in Massachusetts (n=74) in early 2009. Non-responders received repeat mailings and were then contacted via telephone or e-mail.

Results: Sixty-three of 74 (85%) EDs responded and 43% had adopted video laryngoscopy. EDs with video laryngoscopy had a higher median annual visit volume than EDs without video laryngoscopy (48,000 vs. 36,500, p=0.04), but had similar mean intubations per week (4.5 vs. 4.4, p=0.97) and mean surgical airways per year (0.7 vs. 1.1, p=0.19). Half of the EDs affiliated with emergency medicine residency programs had video laryngoscopy available. Among EDs with video laryngoscopy, the technology had been available for>5 years in 4% (1/27), 1-5 years in 44% (12/27), and<1 year in 52% (14/27). Although EDs not using video laryngoscopy did not do so primarily because it was too expensive (69% [25/36]), video laryngoscopy adoption has still progressed more rapidly than predicted by the typical technology adoption timeline.

Conclusion: Video laryngoscopy has been adopted by 43% of Massachusetts EDs; results were similar in academic institutions. Cost is the primary barrier to adoption for non-user EDs, but adoption is progressing more rapidly than expected for a new technology.