From the Division of Pediatric Emergency Medicine, Departments of Emergency Medicine and Pediatrics, Alpert Medical School of Brown University and Rhode Island Hospital/Hasbro Children's Hospital; Lifespan Medical Simulation Center, Providence, RI.
Departments of Pediatrics (Section of Pediatric Emergency Medicine) and Emergency Medicine, Yale University School of Medicine, New Haven, CT.
Pediatr Emerg Care. 2024 Aug 1;40(8):575-581. doi: 10.1097/PEC.0000000000003223. Epub 2024 Jul 27.
To inform development of a preintubation checklist for pediatric emergency departments via multicenter usability testing of a prototype checklist.
This was a prospective, mixed methods study across 7 sites in the National Emergency Airway Registry for Pediatric Emergency Medicine (NEAR4PEM) collaborative. Pediatric emergency medicine attending physicians and senior fellows at each site were first oriented to a checklist prototype, including content previously identified using a modified Delphi approach. Each site used the checklist in 2 simulated cases: an "easy airway" and a "difficult airway" scenario. Facilitators recorded verbalization, completion, and timing of checklist items. After each simulation, participants completed an anonymous usability survey. Structured debriefings were used to gather additional feedback on checklist usability. Comments from the surveys and debriefing were qualitatively analyzed using a framework approach. Responses informed human factors-based optimization of the checklist.
Fifty-five pediatric emergency medicine physicians/fellows (4-13 per site) participated. Participants found the prototype checklist to be helpful, easy to use, clear, and of appropriate length. During the simulations, 93% of checklist items were verbalized and more than 80% were completed. Median time to checklist completion was 6.2 minutes (interquartile range, 4.8-7.1) for the first scenario and 4.2 minutes (interquartile range, 2.7-5.8) for the second. Survey and debriefing data identified the following strengths: facilitating a shared mental model, cognitively offloading the team leader, and prompting contingency planning. Suggestions for checklist improvement included clarifying specific items, providing more detailed prompts, and allowing institution-specific customization. Integration of these data with human factors heuristic inspection resulted in a final checklist.
Simulation-based, human factors usability testing of the National Emergency Airway Registry for Pediatric Emergency Medicine Preintubation Checklist allowed optimization prior to clinical implementation. Next steps involve integration into real-world settings utilizing rigorous implementation science strategies, with concurrent evaluation of the impact on patient outcomes and safety.
通过对儿科急诊预插管检查表原型进行多中心可用性测试，为儿科急诊部门制定预插管检查表提供信息。
这是一项在国家儿科急诊气道登记处（NEAR4PEM）合作研究中的 7 个地点进行的前瞻性、混合方法研究。每个地点的儿科急诊主治医生和高级研究员首先接受检查表原型的培训，包括使用改良 Delphi 方法先前确定的内容。每个地点在 2 个模拟病例中使用检查表：一个“易气道”和一个“难气道”场景。主持人记录清单项目的口头表达、完成情况和时间。每次模拟后，参与者完成匿名可用性调查。使用结构化的讨论来收集有关检查表可用性的额外反馈。检查表的可用性优化基于对调查和讨论的意见进行了定性分析。
55 名儿科急诊医生/研究员（每个地点 4-13 名）参与了研究。参与者认为原型检查表很有帮助、易于使用、清晰且长度适中。在模拟过程中，93%的清单项目都进行了口头表达，超过 80%的项目都完成了。第一个场景的检查表完成时间中位数为 6.2 分钟（四分位距，4.8-7.1），第二个场景为 4.2 分钟（四分位距，2.7-5.8）。调查和讨论数据确定了以下优点：促进了共享的心理模型、减轻了团队领导的认知负担以及提示了应急计划。检查表改进的建议包括澄清具体项目、提供更详细的提示以及允许机构特定的定制。将这些数据与人类因素启发式检查相结合，生成了最终的检查表。
基于模拟的、针对儿科急诊预插管检查表的人类因素可用性测试允许在临床实施之前进行优化。下一步是将其整合到真实环境中，利用严格的实施科学策略，并同时评估对患者结局和安全的影响。
