WIP 2 - Attainment and maintenance of neonatal intubation competency

Poster Number: WIP 2
Publication Number: WIP 2.2642

Background: Tracheal intubation (TI) is a critical skill for Neonatal-Perinatal Medicine (NPM) fellows. There is high variability among fellows in the acquisition & maintenance of TI competency. Moreover, there are diminishing opportunities for fellows to attempt TI due to the use of noninvasive respiratory support in neonates & the increasing presence of non-physician airway providers in the NICU. Once competent in TI, it is unclear how rapidly skills deteriorate between TI encounters.

Objective: Determine the amount of time between TI encounters associated with TI skill deterioration causing TI attempt failure among NPM fellows at the Children’s Hospital of Philadelphia (CHOP).
Identify the time interval between TI encounters that predicts TI failure to allow for the provision of procedural refresher education for at-risk airway providers & an equitable way to prioritize TI opportunities for airway providers.

Design/Methods: Using data submitted to the National Emergency Airway Registry for Neonates (NEAR4NEOS), a retrospective review of NPM fellow TI encounters was performed. 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 were 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. Cumulative sum analysis (CUSUM) will be used to remove encounters that occur before fellows achieve TI competency (>80% overall success) to minimize the impact of unsuccessful TI’s during initial skill acquisition on the data. Data will be analyzed using the first-order Markov conditional linear expectation approach for analysis of longitudinal data. Analysis completion is expected by February 2024. We hope to identify a critical time point between TI encounters which is associated with TI failure.