393 - Creation of an Implementation Blueprint for the National Emergency Airway Registry for Pediatric Emergency Medicine (NEAR4PEM) Pre-Intubation Checklist

Publication Number: 4385.393

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; Ilana Harwayne-Gidansky, Albany Medical College, Albany, NY, United States; Michael P.. Goldman, Yale School of Medicine, New Haven, CT, United States; Joshua Nagler, Boston Children's Hospital, Boston, MA, United States; Joshua Ray Tanzer, Brown University Health, Providence, RI, United States; natalie Napolitano, Children's Hospital of Philadelphia, Drexel Hill, PA, United States; Akira Nishisaki, Children's Hospital of Philadelphia, Philadelphia, PA, United States

Background: NEAR4PEM developed an evidence-based pre-intubation checklist, however, successfully translating this quality improvement tool into practice for improved intubation outcomes in the Pediatric Emergency Department (PED) requires attention to implementation. Given the complex conditions influencing checklist use, it is essential to work with key informants to understand multilevel determinants and identify the most effective strategies for successful implementation.

Objective: To apply implementation science methodology to systematically identify barriers to checklist adoption and to prioritize and detail targeted strategies within an implementation blueprint to support its successful integration into clinical practice.

Design/Methods: Participants included NEAR4PEM Airway Champion (AC) teams composed of physicians, nurses, pharmacists, and respiratory therapists, in addition to implementation science experts. Our methodology consisted of a modified conjoint analysis, with five steps. Step 1 was a mixed methods formative evaluation, utilizing focus groups and surveys for identification of barriers and facilitators to checklist implementation. In Step 2, key informants prioritized the identified barriers according to feasibility and impact quantitatively via survey. In Step 3, the prioritized barriers were matched with implementation strategies from a published compilation (Expert Recommendations for Implementation Change, ERIC). In Step 4, these strategies were ranked for feasibility and impact. Finally, in step 5, prioritized implementation strategies were detailed in an implementation blueprint. (Figure 1)

Results: In Step 1, ACs from 13 sites completed 45 surveys, which - together with prior focus groups - identified 16 unique barriers. For Step 2, these key informants prioritized 6 barriers of high impact and high feasibility. For Step 3, an implementation science team assisted ACs with selection of 24 ERIC strategies. In Steps 4 and 5, Advisory Board members prioritized 19 ERIC strategies and incorporated them into an implementation blueprint, detailing how each could be applied across different phases to guide future airway teams. (Table 1)

Conclusion(s): We developed a blueprint for implementing an airway checklist in PEDs that identifies and addresses key barriers and prioritizes detailed strategies to guide the process. Future steps involve implementation of the checklist in practice with concurrent evaluation of implementation and patient outcomes.

Figure 1. Methodology for Implementation Blueprint Creation
This figure demonstrates the five steps of our methodology, grouped by goals and team meetings with resulting outputs (further described in Results). IPT: Implementation Planning Team

Table 1. Implementation Blueprint
Barrier - prioritized barriers, identified by CFIR 2.0 qualitative focus groups and surveys; ERIC Strategy - Expert Recommendations for Implementing Change, all strategies originated during IS working group meetings unless otherwise noted; Operationalization - informed by Proctor framework for reporting strategies (Proctor, 2013); Related Resource - tools created to enact strategies.
a Preplanned Strategy, b Preplanned strategy and from IS working group
AC: Airway Champions, AB: Advisory Board, QI: Quality Improvement