202 - Designing for Humans: The Human Factors-Informed Design of a Tracheal Intubation Checklist for Pediatric Emergency Departments

Poster Number: 202
Publication Number: 202.1780

Background: Tracheal intubation (TI) is high-risk. The National Emergency Airway Registry for Pediatric Emergency Medicine (NEAR4PEM) is developing a safety checklist for TIs specifically designed for use in pediatric emergency departments (PEDs). Optimal checklist performance requires thoughtful design and workflow integration, which can be accomplished by human factors (HF) formative usability testing, a methodology of iterative evaluation of design and functionality by users to support their unique needs.

Objective: To utilize HF formative usability testing to optimize the content and design of a previously published NEAR4PEM TI checklist to meet the cognitive and workflow requirements of PEM physicians.

Design/Methods: PEM physicians from 4 institutions participated in 2 methods of formative testing using virtual collaborative software, Fig1. One group participated in card sort exercises to order the 5 content categories from the previous NEAR4PEM TI checklist to match PED workflow. Results were evaluated for group differences using the Kruskal-Wallis test. Pairwise comparisons were used to find the relative order of categories by median rank.
A second group participated in focus groups led by HF engineers using semi-structured interviewing to understand barriers and facilitators of TI. Recurring themes were grouped and summarized to guide design.

Results: Fourteen PEM physicians participated in individual card sort exercises. Two statistically significant order groupings emerged, revealing consensus amongst participants that the content categories "Pharmacy", "Patient Assessment/Plan", and "Personnel" should appear above the categories of "Equipment" and "Patient Preparation". However, there were no statistically significant differences in ranking within groupings, so final order was established by coupling each category's median rank with qualitative responses, Fig2.
Fifteen PEM physicians participated in 4 focus groups,1 per institution. Participants expressed broad support for use of a TI checklist. Overarching themes that informed design are summarized in Fig2. Feedback that differed across participants, like available equipment, permissibility of trainee participation, availability of emergency backup, and prior experience with checklist use, suggested the need for customizability of the tool. The resulting prototype is shown in Fig3.

Conclusion(s): HF formative testing facilitated the integration of user-centered feedback to establish the order structure and design of a TI checklist for PEDs. Testing also revealed that institutional customization may best support the generalizability of the tool.