Fellow Icahn School of Medicine at Mount Sinai New York, New York, United States
Background: Responsibility for pre-operative intubation of neonates is shared between the neonatology and anesthesiology teams at a Level IV NICU, with a set of pre-specified criteria guiding which team performs the procedure. Clear documentation and communication of challenges related to intubation and bag-mask ventilation can help facilitate and guide the approach to future intubations and is essential when specialists from different teams are responsible for performing the procedure across the spectrum of a patient’s care. The ability to clearly transmit information is impacted by conflicting definitions of difficult intubation or critical airway, frequently rotating clinical teams, and variability in procedure documentation. Objective: Standardize intubation documentation, define difficult neonatal intubations, and create a method of tracking incidences of difficult intubations over time. Design/Methods: Consensus regarding critical elements to include in intubation documentation was achieved among a multidisciplinary team. The first PDSA cycle included the drafting of a new intubation procedure note template and a two-week pilot with intubating physicians in the NICU. In the second PDSA cycle, the updated note template will be evaluated in conjunction with education for providers by pediatric anesthesiologists on airway views, frequently utilized airway maneuvers, and intubation techniques. Compliance with the template for intubation procedures is being tracked over time. Surveys will be used to elicit comparative data between prior documentation and current documentation with respect to efficacy in communicating essential information. In cases where anesthesiologists perform intubations subsequent to NICU provider intubations, surveys will be used to identify whether the new template facilitated procedure success. Infants who have had multiple intubations documented with the new template will be reviewed for consistency. As a balancing measure, the time required to complete procedure note documentation is being monitored for any significant change.
