Verbal Communication During Airway Management and Emergent Endotracheal Intubation: Observations of Team Behavior Among Multi-institutional Pediatric Intensive Care Unit In Situ Simulations

Abstract

Objective To assess health-care teams’ verbal communication, an observable teamwork behavior, during simulations involving pediatric emergency airway management and intubation. Methods We conducted video-recorded, risk-informed in situ simulations at 5 hospitals with pediatric intensive care units in the Chicago, Illinois, area. Clinicians participated in their clinical roles (eg, attending physician, bedside nurse) and had access to hospital operational systems (eg, electronic health record, medical imaging, laboratory services). Video-recordings were transcribed; 3 pediatric critical care physicians analyzed the transcripts to assess preintubation communication: (a) the declaration of an airway emergency, (b) intubation medication request(s), and (c) preintubation medication administration. Results Ten pediatric intensive care unit simulations were analyzed. Statements to notify the care team of an airway emergency varied widely. In 3 simulations, a dosage for every medication was verbalized in the physician’s initial medication request; however, in 4 simulations, a nurse was the first to verbalize the medication dosage(s) before administration. In 6 of the simulations where preintubation medications were administered, multiple requests for medications were verbalized. A clinician verbally confirmed that each medication was administered in only 2 of the simulations. Conclusions No uniform statement was identified to declare an airway emergency among the care teams. Preintubation medication dosages were not consistently included in intubation medication orders, and frequently, there were multiple requests to obtain medications. Using standardized language to declare an airway emergency and verbally communicating medication requests and dosages and confirming administration may improve the quality of care in this critical event.

Call for Manuscripts

“…Often, critically ill patients cannot express their uncomfortable feeling of dry mouth due to the intubation or undersedation. 44 It is essential that clinicians consider alternatives or deprescribing medications with anticholinergic adverse effects by reviewing the benefit-harm ratio and the likelihood of withdrawal reaction. 45 Not only xerostomia but also the anticholinergic burden can alter consciousness such as delirium, which is associated with significantly increased morbidity and mortality rates in critically ill patients.…”

Anticholinergic Burden and Xerostomia in Critical Care Settings

“…The anticholinergic burden on xerostomia could be more significant, considering communication difficulties among critically ill patients. Often, critically ill patients cannot express their uncomfortable feeling of dry mouth due to the intubation or undersedation 44 . It is essential that clinicians consider alternatives or deprescribing medications with anticholinergic adverse effects by reviewing the benefit-harm ratio and the likelihood of withdrawal reaction 45 .…”

The Association of Teamwork and Adverse Tracheal Intubation–Associated Events in Advanced Airway Management in the PICU

“…15 29 30 However, there have been limited number of studies evaluating teamwork during emergency airway management. 31 32 33 34 In an observational study in the PICU, the performance of bedside teams with ≥2 team members who had undergone recent simulation training was significantly better using a standardized scale (Just-In-Time Pediatric Airway Performance Scale: JIT-PAPPS). 35 Similar studies demonstrate that teamwork behaviors for emergent airway management can be taught and potentially improve outcomes.…”