 Hello, I'm Dr. Kanowitz. I'm the founder of the Airway Safety Movement. I'm the co-chair of the Patient Safety Movement Foundation's Airway Safety Workforce. And I'm the founder, chairman, and chief medical officer of Securescent Medical. We are forming an adult hospital solutions for Airway Safety Network, whose purpose will be to take aim at zero preventable deaths and harm from unplanned extubation. And we will do this through widespread implementation of evidence-based best practices. I always like to start with why. Why we do what we do every day. And our why is this young gentleman, Drew Hughes. Drew unfortunately died at age 13, not from the minor head injury that he sustained while skateboarding. He died from the complications of the management of his airway. He died from preventable medical errors. Unplanned extubation is both common and costly. It is estimated that there are 121,000 incidents in adult ICUs in the US alone. Complications of unplanned extubation include ventilator-associated pneumonia, hemodynamic instability, vocal cord paralysis, brain injury, and death. Unplanned extubation increases the ICU length of stay from nine to 18 days and leads to $5 billion in preventable health care costs. The gravity of this safety event is commonly not acknowledged as a valid problem despite the plethora of literature that is out there supporting how common and costly it really is. Many clinicians think of unplanned extubation as simply the cost of doing business, rather than as a preventable safety event. Many institutions do not track UE, and many do not deploy preventive measures. Hospitals must do four things in order to improve their quality process and take aim at zero preventable deaths and harm. First, hospitals should do an assessment to determine where your hospital UE rate falls on the spectrum of unplanned extubation amongst adult hospitals. That rate being 0.5% to 35%. Hospitals C-level executives need to empower their quality and safety teams and provide the necessary resources to elevate unplanned extubation to a level of a key performance measure. Hospitals should institute tools for tracking and implement known best practices. The Children's Hospital's Solutions for Patient Safety has defined evidence-based practices for decreasing UE and related complications in the pediatric and neonatal populations. Dr. Sarah Kandel from Yale New Haven Children's Hospital showed that they could reduce their rate of UE hospital-wide by 75%. Dr. Galliote from the Children's National Medical Center showed that they were able to reduce their UE rate in a level four NICU by 61%. And Dr. Klugewin in a study that was just published this spring in JAMA Pediatrics showed that the network aggregate for reduction in UE events was 24%. So now we are forming an adult hospitals network patterned after this Children's Hospital's Solutions for Patient Safety Network. The network will apply QI methods and interventions that have already been proven by the children's network track the effectiveness of those bundles, determine what QI bundle most likely will reduce UE in adults. Once that is all determined, then we will hopefully get some of the network partners to perform clinical studies like they did through the Children's Network to evaluate the effectiveness of the bundle, publish those results, disseminate the information widely to encourage broad adoption of best practices and encourage all hospitals to participate in the airway safety network. It is important to have several critical strategies for effective quality improvement. These include having a culture of safety that is a just culture. And also to make sure that the data that is collected is accurate. And I believe it is necessary to classify and track every extubation if we're gonna get to being able to eliminate unplanned extubation. In the Patient Safety Movement Foundation's Actionable Patient Safety Solutions, number 8B, which is adult unplanned extubation, we have published this extubation classification. The way this works is with every extubation, whether planned or unplanned, every single extubation gets classified. And the way you classify that is you determine that when the endotracheal tube was removed were three things done. Was readiness for safe removal of the endotracheal tube determined? Was removal of the endotracheal tube intentional? And was removal of the endotracheal tube controlled? So if a patient had gone through a readiness for safe removal of the endotracheal tube, they had an assessment for liberation potential. They underwent successful strategic wean. And because of that, the practitioner determined that they wanted to remove the tube that it was timed and they then did that by preparing the patient, deflating the balloon and removing the tube in a controlled manner, that would be a planned extubation. Anything that does not fit those three criteria, then fit into a type of unplanned extubation. For instance, whether or not they've gone through a wean, if the removal of the tube was unintentional and the tube was removed in an uncontrolled manner, meaning the balloon was not deflated and the patient was not prepared for the extubation, those are types of extubation that include self-extubation, the patient pulls the tube themselves or accidental extubation. Somebody trips on the ventilator tubing and pulls the tube out. There are other types of unplanned extubation such as you determine you want to remove the tube and the tube is removed controlled, but it's not done under the normal weaning process. You're having to do it either because the device has malfunctioned or you're not sure, but there's a presumed internal dislodgement of the tube. Those are also considered unplanned extubation. So with this classification, you can determine the exact type of every extubation and then we can with that determine what are the risks of the different types of extubation. So we have formed our initial cohort of our adult hospitals solutions for airway safety network. They include the University of Colorado Health Memorial Hospital, University of California Irvine Health and Parish Healthcare. Now, due to COVID, the start of the network has been slow, but we're hoping once we get beyond COVID that we will really be able to kick the network into gear. Now, every hospital should join the adult hospitals network. If you currently track UE and your rate is zero or even less than the national benchmark of one unplanned extubation per 100 ventilator days, you are a best practice. And we need you in the network to help share with other hospitals your experiences, how you were able to obtain your unplanned extubation rate. If you currently track UE, but your rate is above the national average, the national benchmark, you should join the network so that you can learn from best practice hospitals what they did to eliminate or decrease unplanned extubation so that you can emulate that. And if you don't currently track UE, then you should join the network to learn from these best practice hospitals how to actually simply track UE and implement QI processes to improve UE. So if you are interested in eliminating preventable death and harm from unplanned extubation, please join the solutions for airway safety network and help us eliminate preventable harm and death from unplanned extubation.