400 - Feasibility Trial of an Implementation Blueprint for the National Emergency Airway Registry for Pediatric Emergency Medicine (NEAR4PEM) Pre-Intubation Checklist

Publication Number: 4392.400

Robyn Wing, The Warren Alpert Medical School of Brown University, Wrentham, MA, United States; Ariana M. Albanese, The Warren Alpert Medical School of Brown University, Providence, RI, United States; Monica Prieto, Childrens Hospital of Philadelphia, Swarthmore, PA, United States; Emily Greenwald, Duke University School of Medicine, Durham, NC, United States; Timmy R. Lin, The Warren Alpert Medical School of Brown University, Providence, RI, United States; Joshua Nagler, Boston Children's Hospital, Boston, MA, United States; Michael P.. Goldman, Yale School of Medicine, New Haven, CT, United States; natalie Napolitano, Children's Hospital of Philadelphia, Drexel Hill, PA, United States; Michael J.. Mello, Rhode Island Hospital, Providence, RI, United States; Akira Nishisaki, Children's Hospital of Philadelphia, Philadelphia, PA, United States

Background: Tracheal intubation (TI) of critically ill and injured children in the pediatric emergency department (PED) is a lifesaving but challenging procedure. Airway checklists have improved outcomes for children undergoing TI in pediatric and neonatal intensive care units. There is currently no rigorously implemented checklist available for TIs in the PED setting. Therefore, NEAR4PEM developed a PED pre-intubation checklist. Using an implementation science approach, we also developed an implementation blueprint, or structured guide, that outlines key strategies to support the successful implementation of the checklist.

Objective: To evaluate the Blueprint's impact on checklist feasibility, acceptability, and perceived preparedness across three diverse PED sites.

Design/Methods: The checklist was implemented at 3 pilot sites guided by the Blueprint. After each TI, PED clinicians were invited to complete an anonymous survey. Checklist acceptability and feasibility were assessed using the Acceptability of Intervention Measure (AIM) and the Feasibility of Intervention Measure (FIM), validated measures of implementation outcomes and "leading indicators" of implementation success. Fidelity was evaluated by self-report of full versus partial completion of checklist items. Participants were also queried about barriers to checklist use and invited to provide qualitative feedback.

Results: 216 clinicians (physicians, nurses, respiratory therapists, and APPs) from emergency medicine, critical care, and trauma surgery participated. (Table 1) Overall, participants found the checklist acceptable (range of four AIM measures, 86 - 90%) and feasible (range of four FIM measures 87 - 92%). (Figure 1) The checklist was reported to be used in 90.7% of intubations and fully completed in 87.5%. The majority of participants (84.1 %) reported that they had received checklist education and 99.7% of these participants reported feeling "very prepared" or "prepared" to use the checklist. The top reported barrier to checklist use was the perception that the checklist would take too long. (Figure 2)

Conclusion(s): The Blueprint facilitated checklist implementation at 3 diverse PEDs with participants finding it to be acceptable and feasible to implement. Checklist fidelity will be further investigated with a video review analysis study. These findings will guide refinement of both the Checklist and Blueprint prior to a fully powered implementation and dissemination study across the NEAR4PEM collaborative and, ultimately, general ED settings.

Table 1. Site and Participant Demographics
*All Level 1 Trauma Centers; **Embedded - PED situated within a larger general ED, shared RNs and RTs with adult ED. Connected to an embedded quaternary Children's Hospital; PEM - Pediatric Emergency Medicine

Figure 1. Checklist Feasibility and Acceptability
Proportion of respondents who agreed/completely agreed with FIM (feasibility of intervention measure) and AIM (acceptability of intervention measure) survey questions about the feasibility and acceptability of the NEAR4PEM Checklist.


Figure 2. Barriers to Checklist Use
Perceived barriers reported as impacting checklist use during intubation.