Resident Physician Children's Hospital of Philadelphia Philadelphia, Pennsylvania, United States
Background: Tracheal intubation (TI) is a critical skill for Neonatal-Perinatal Medicine (NPM) fellows. The number of TI encounters during NPM fellowship is variable and poorly catalogued due to inaccuracies in self-reported procedure logs. There is no consensus on the number of TI encounters needed to achieve general neonatal TI competency. TI competency for infants with lower birth weights and gestational ages may be difficult to achieve during fellowship given their limited number. With increasing use of non-invasive respiratory support and non-physician airway providers, it remains unknown if NPM fellows experience sufficient TI encounters to develop competency in TI even at high-volume, high-risk delivery hospitals. Objective: Describe the volume of TI opportunities & the evolution of fellow TI competency within the Children’s Hospital of Philadelphia (CHOP) NPM fellowship program. Design/Methods: Using data submitted to the National Emergency Airway Registry for Neonates (NEAR4NEOS), a retrospective review of NPM fellow TI encounters was conducted. This project has QI designation by CHOP’s IRB. Each TI encounter is tagged with an intubator ID number which links TI encounters to individual fellows. 457 TI encounters by 55 NPM fellows were identified between 2017-2022. The encounters occurred in the delivery room or NICU at CHOP & its delivery hospital. Encounters where fellows needed ≤2 attempts to intubate the trachea with ETCO2 confirmation are classified as successful. Raw TI data will be cleaned by November 2023. The mean & median number of intubations attempted & completed during fellowship & TI attempts for subpopulations by birthweight will be reported. Cumulative sum analysis will be used to assess fellows’ progression toward achieving TI competency (>80% overall TI success) among all neonates as well as subpopulations by birthweight. TI competency assessment will be determined with & without TI pre-medication & use of video laryngoscopy. Analysis completion is expected by February 2024.
