198 - Usability Testing Via Simulation: Optimizing the NEAR4PEM Pre-Intubation Checklist

Poster Number: 198
Publication Number: 198.1687

Background: Tracheal intubation of children in the pediatric emergency department (PED) is an infrequent, high-risk procedure. Airway checklists have improved outcomes for children undergoing intubation in other settings. The National Emergency Airway Registry for Pediatric Emergency Medicine (NEAR4PEM) developed a prototype checklist for use in the PED.

Objective: We aimed to 1) complete simulation-based usability testing of a NEAR4PEM Pre-Intubation Checklist prototype and 2) use iterative feedback to optimize the checklist before implementation.

Design/Methods: PEM attending physicians and senior fellows across 7 NEAR4PEM sites were invited to participate. Participants used the prototype as a cognitive aid and to initiate a pre-procedural timeout during 2 simulated cases: an “easy airway” (post-ictal respiratory failure) and one of two “difficult airway” scenarios (congenital airway abnormality or trauma with spinal motion restriction). During simulations, facilitators recorded standardized airway performance data, including time to checklist completion. After each scenario, participants completed an anonymous survey rating checklist usability. After the second simulation, structured debriefings were used to gather additional participant feedback on the tool and its usability. Survey and debrief responses were transcribed, and qualitative analysis was performed using a framework approach.

Results: Fifty-five PEM physicians participated. Participants surveyed found the checklist to be helpful, easy to use, clear, and an appropriate length (Table 1). Median time to checklist completion was 6.2 min (IQR 4.8, 7.1) for the first scenario and 4.2 min (IQR 2.7, 5.75) for the second. Thematic analysis of the debriefing revealed strengths and weaknesses of the checklist (Table 2). Perceived weaknesses were used to optimize the prototype checklist. Optimization included clarification of wording, identification of areas for site-specific customization, and inclusion of a more explicit procedural “time out” section (Figure 1).

Conclusion(s): Simulation-based usability testing of the NEAR4PEM Pre-Intubation Checklist prototype allowed optimization prior to clinical implementation. Next steps include integration into clinical settings utilizing rigorous implementation strategies, with concurrent evaluation of the impact on clinical outcomes and patient safety.