577 - Using a quality improvement framework to improve first attempt intubation success in a neonatal intensive care unit

Publication Number: 3558.577

Elizabeth H. Murphy, The National Maternity Hospital, Dublin 14, Dublin, Ireland; Laura Ryan, National Maternity Hospital Dublin, Dublin 6W, Dublin, Ireland; Caitríona Ní Chathasaigh, National Maternity Hospital, Dublin, Ireland, Dublin, Dublin, Ireland; Carmel Maria. Moore, National Neonatal Tranport Team, Dublin, Dublin, Ireland; Linda Smiles, The National Maternity Hospital, Dublin, Dublin, Ireland; Eoin O Currain, National Maternity Hospital, Dublin, Dublin, Ireland; Anna Curley, NMH, dublin, Dublin, Ireland

Background: Neonatal intubation is an essential and potentially life-saving procedure performed by paediatricians and neonatologists. It is not without risk, however and neonates are particularly vulnerable to physiologic instability with prolonged or multiple attempts. Historically, first attempt intubation success rates among paediatricians are low, with a rate of only 49% according to US registry data (Foglia et al, 2019). Also, there are now reduced opportunities for trainees to achieve the clinical exposure needed for competency. Recent interventions such as the advent of video laryngoscopy have the potential to improve these rates.

Objective: We developed a quality improvement initiative in neonatal intubation in order to improve intubation success on first attempt.

Design/Methods: This study was carried out in a single centre tertiary maternity hospital in Dublin, Ireland with c. 7000 births annually. Quality improvement programme (QIP) involved set up of multidisciplinary quality improvement team, risk reduction through use of protocols and intubation checklists, “Plan Do Study Act’ (PDSA) cycles throughout initiative focused on multidisciplinary education, encouraging staff buy-in, staff feedback and outcome rate monitoring, high impact evidence translated to clinical care with introduction of video laryngoscopy, inter professional education and simulation, introduction of a just-in time educational video before intubation. Outcomes collected included rate of first time intubation success in all intubations preterm and term on the neonatal intensive care unit.

Results: 70% of intubation attempts in our NICU are carried out in the first instance by residents or first year fellows. The baseline rate of first-attempt intubation success pre-QIP initiative (2021) was 40%. Following introduction of our QIP initiative, our first-attempt rates improved to 60% by 2023 and further improved to 76% by end of 2025.

Conclusion(s): The introduction of our quality improvement initiative for intubation including most notably the introduction of video laryngoscopy was successful in increasing first time intubation success rates in preterm and term babies in our neonatal unit. In addition, staff feedback has been universally positive. Our findings are generalizeable to similar settings worldwide.