272 - Use of Video Review to Improve Pediatric Emergency Department Intubations First-Pass Success: A Quality Improvement Initiative

Publication Number: 272.6891

Anne Runkle, Ohio State University College of Medicine, Columbus, OH, United States; Jessica Gillespie, Nationwide Children's Hospital, Delaware, OH, United States; Sarah Chen, Nationwide Children's Hospital, Columbus, OH, United States; Abha Athale, Nationwide Children's Hospital, Columbus, OH, United States; Katherine A. Roland, Nationwide Children's Hospital, Marysville, OH, United States; Punam Shingala, Nationwide Children’s Hospital, Powell, OH, United States

Background: Intubation in the Pediatric Emergency Department (ED) is a low-frequency high-acuity procedure. First-pass success (FPS) is associated with decreased rates of adverse events including hypoxia, aspiration, and cardiac arrest. Previous studies have reported the use of intraoral video laryngoscopy (VL) recordings for both quality assurance and educational initiatives. We sought to improve ED FPS by implementing a video review curriculum to improve trainee knowledge and confidence in pediatric airway management.

Objective: To increase pediatric ED intubation first-pass success to 80% within one year of implementing a video-based intubation curriculum.

Design/Methods: A multidisciplinary team was formed and identified barriers to FPS amenable to educational intervention (Fig 1). In April 2023, ED staff began recording intraoral videos of all VL intubation attempts. Trainees also completed a standard post-intubation survey. Videos were deidentified and saved on a secure drive. Videos were reviewed and used for educational interventions beginning in October 2023: quarterly pediatric emergency medicine (PEM) fellow video review sessions, EM resident video review sessions, PEM fellow Difficult Airway Day, and a PEM faculty Difficult Airway Course focused on coaching trainees. Emphasis was placed on techniques for infant intubation, based on post-intubation survey responses and low FPS in patients under two years old.

15 PEM fellows participated in quarterly video review sessions and a Difficult Airway Day, and 66 EM residents and PEM faculty reviewed a standardized set of pediatric intubation videos. Intubation data from January 2020-October 2024 was included for FPS analysis. All rapid sequence intubations performed by ED team members were included. Balancing measures included duration of intubation attempt and frequency of hypoxia during intubation.

Results: 499 intubations from January 2020-October 2024 were analyzed. To decrease seasonal variability in intubation numbers, results were reported on a quarterly basis. FPS improved from a baseline of 73% to 95% in Q3 2024 (Fig 2). FPS since initiation of the video curriculum was 83%, with all 5 quarters to date above the mean. Of note, there was improvement in FPS in patients < 2 years, from a baseline of 61% to 91% in Q3 2024, with 75% FPS in the 5 quarters since curriculum implementation (Fig 3).

Conclusion(s): These preliminary results show that implementation of a video-based intubation curriculum may be a promising tool to increase FPS in the pediatric ED. Next steps include curriculum integration into trainee orientation and faculty continuing education.

Figure 1: Key Driver Diagram


Figure 2: First-Pass Success (FPS) in Pediatric Emergency Medicine Intubations, All Patients


Figure 3: First-Pass Success (FPS) in Pediatric Emergency Medicine Intubations, Patients Under 2 Years Old