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. 2023 Oct 4:2023:4504934.
doi: 10.1155/2023/4504934. eCollection 2023.

Comfort and Coordination among Interprofessional Care Providers Involved in Intubations in the Pediatric Intensive Care Unit

Chetna K Pande  1 , Kelsey Stayer  1 , Thomas Rappold  2 , Madeleine Alvin  3 , Keri Koszela  4 , Sapna R Kudchadkar  5   6   7
Affiliations

Comfort and Coordination among Interprofessional Care Providers Involved in Intubations in the Pediatric Intensive Care Unit

Chetna K Pande et al. Crit Care Res Pract. .

Abstract

Background: Successful execution of invasive procedures in acute care settings, including tracheal intubation, requires careful coordination of an interprofessional team. The stress inherent to the intensive care unit (ICU) environment may threaten the optimal communication and planning necessary for the safe execution of this complex procedure. The objective of this study is to characterize the perceptions of interprofessional team members surrounding tracheal intubations in the pediatric ICU (PICU).

Methods: This is a single-center survey-based study of staff involved in the intubation of pediatric patients admitted to a tertiary level academic PICU. Physicians, nurses, and respiratory therapists (RT) involved in tracheal intubations were queried via standardized, discipline-specific electronic surveys regarding their involvement in procedural planning and overall awareness of and comfort with the intubation plan. Qualitative variables were assessed by both Likert scales and free-text comments that were grouped and analyzed thematically.

Results: One hundred and eleven intubation encounters were included during the study time period, of which 93 (84%) had survey responses from at least 2 professional teams. Among those included in the analysis, the survey was completed 244 times by members of the PICU teams including 86 responses from physicians, 76 from nurses, and 82 from RTs. Survey response rates were >80% from each provider team. There were significant differences in interprofessional team comfort with nurses feeling less well informed and comfortable with the intubation plan and process compared to physicians and RTs (p < 0.001 for both). Qualitative themes including clear communication, adequate planning and preparation prior to procedure initiation, and clear definition of roles emerged among both affirmative and constructive comments.

Conclusions: Exploration of provider perceptions and emergence of constructive themes expose opportunities for teamwork improvement strategies involving intubations in the PICU. The use of a preintubation checklist may improve organization and communication amongst team members, increase provider morale, decrease team stress levels, and, ultimately, may improve patient outcomes during this high stakes, coordinated event.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
PICU RN and RT experience.
Figure 2
Figure 2
Awareness and comfort of team members with intubation process.
Figure 3
Figure 3
Comfort and awareness of team members with intubation process by a Likert scale.
See this image and copyright information in PMC

References

    1. Nishisaki A., Turner D. A., Brown C., Walls R. M., Nadkarni V. M. A National Emergency Airway Registry for children: landscape of tracheal intubation in 15 PICUs. Critical Care Medicine . 2013;41(3):874–885. doi: 10.1097/ccm.0b013e3182746736. - DOI - PubMed
    1. Parker M. M., Nuthall G., Brown C., et al. Relationship between adverse tracheal intubation associated events and PICU outcomes. Pediatric Critical Care Medicine . 2017;18(4):310–318. doi: 10.1097/pcc.0000000000001074. - DOI - PMC - PubMed
    1. Nishisaki A., Lee A., Li S., et al. Sustained improvement in tracheal intubation safety across a 15-center quality-improvement collaborative: an interventional study from the national emergency airway registry for children Investigators∗. Critical Care Medicine . 2021;49(2):250–260. doi: 10.1097/ccm.0000000000004725. - DOI - PubMed
    1. Umoren R. A., Sawyer T. L., Ades A., et al. Team stress and adverse events during neonatal tracheal intubations: a report from NEAR4NEOS. American Journal of Perinatology . 2019;37(14):1417–1424. doi: 10.1055/s-0039-1693698. - DOI - PubMed
    1. Pronovost P., Needham D., Berenholtz S., et al. An intervention to decrease catheter-related blood stream infections in the ICU. New England Journal of Medicine . 2006;355(26):2725–2732. doi: 10.1056/nejmoa061115. - DOI - PubMed

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