WIP 6 - Introducing Video Laryngoscopy for Endotracheal Intubation in a Level III Academic NICU: A Quality Improvement Initiative

Poster Number: WIP 6
Publication Number: WIP 6.2589

Background: Neonatal endotracheal intubation can be a challenge for inexperienced and experienced providers, attributed to this population's unique anatomy and limited respiratory reserve. As a result, multiple intubation attempts are often necessary resulting in adverse events. Video laryngoscopy (VL), which enhances the viewing angle during endotracheal intubation, has reduced adverse events and improved first-attempt success rates among trainees. Implementation of Rapid Cycle Deliberate Practice (RCDP), where learners repeatedly perform a simulation interjected with micro-debriefs, can help rapidly acquire clinical skills.

Objective: Our primary goals are to demonstrate a 20% increase in VL utilization, 20% increase in first-attempt success rate among trainees using VL over 12 months beginning in March 2023.

Design/Methods: This Quality Improvement (QI) project initiative was approved by the QI committee board at our institution to be implemented in our level III academic Neonatal Intensive Care Unit (NICU). Before March 2023, VL was not used clinically on our unit, and our baseline data showed our NICU providers had minimal experience with VL. We then implemented RCDP simulation sessions to introduce and integrate NeoView VL on high-fidelity mannequins. Before initiating these sessions, all participants were surveyed to assess their confidence using a 5-point Likert scale in utilizing and teaching with VL. This survey was repeated at six-month intervals after introduction as well. Concurrently, interdisciplinary teaching sessions were conducted with nursing staff and respiratory therapists.
After completing the initial RCDP sessions, VL was implemented clinically for nonemergent endotracheal intubations and Less Invasive Surfactant Administration procedures. Following each endotracheal intubation procedure on our unit, regardless of whether using VL or direct laryngoscopy, providers completed a worksheet providing patient background data, number of intubation attempts, and adverse events. Data collection is ongoing and will be analyzed using a statistical control chart.