585 - Neonatal-perinatal fellow endotracheal intubation skill acquisition is impeded by advancements in medical technology.

Poster Number: 585
Publication Number: 585.117

Mary F. Keith, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States; Bianca E. LoVerde, West Virginia University Children's Hospital, Morgantown, WV, United States

Background: Neonatal-Perinatal (NP) fellows have performed fewer intubations in the Neonatal Intensive Care Unit (NICU) over the past several years. Contributing factors may include competition with other provider types or introduction of new noninvasive ventilation techniques. Decreased endotracheal intubation threatens NP fellow procedural competency and risks creation of attending physicians who are unable to support patient needs.

Objective: To determine the primary factor that affects the number of endotracheal intubations performed by NP fellows in the NICU.

Design/Methods: We performed a retrospective chart review of all neonates who required endotracheal intubation from September 2016 through August 2020 at University of Pittsburgh Medical Center’s academic NICUs: Magee-Womens Hospital (level 3 NICU) and Children’s Hospital of Pittsburgh (level 4 NICU). Both are staffed at all times by neonatology attendings and advanced practice providers (APPs), while NP fellows are always in the level 3 NICU but only in the level 4 NICU on weekdays. Bubble CPAP (bCPAP), a type of noninvasive ventilatory support, was introduced to both NICUs in September 2018. The intubation note author was deemed the provider type that performed the intubation.

Results: After initiation of bCPAP, the average number of endotracheal intubations at the level 3 NICU significantly decreased for NP fellows from 15.4 to 7.2 per month (p < 0.0001, one-way ANOVA with multiple comparisons) and for APPs from 5.0 to 2.9 per month (p < 0.05). The average number of intubations at the level 4 NICU decreased for NP fellows from 3.6 to 2.0 per month and APPs from 18.8 to 8.0 per month (p < 0.0001). The percentage of intubations performed by NP fellows at both the level 3 and level 4 NICU was largely unchanged. At the level 4 NICU, the percentage of intubations fell for APPs from 76.8% to 60.2% (p < 0.0001) but rose for attendings from 5.6% to 19.0% (p < 0.0001).Conclusion(s): NP fellows performed significantly fewer intubations after initiation of bCPAP. The proportion of intubations performed by NP fellows compared to APPs and neonatology attendings was unchanged. This suggests that competition with other provider types did not impede fellow intubations, and was instead due to a new noninvasive ventilatory technique. Neonatology attendings had a larger proportion of intubations compared to APPs at the level 4 NICU, which may represent more desire to intubate or a need for attendings to intubate when others were unsuccessful. Focus needs to be placed on prioritizing fellows for intubations and exploring other training avenues to ensure procedural competency.
Average number of endotracheal intubations performed per month by different provider types at Magee-Womens Hospital level 3 NICU before and after initiation of bubble CPAP.The average number of intubations performed by NP fellows and APPs decreased, from 15.4 to 7.2 per month (****p < 0.0001) and from 5.0 to 2.9 per month (*p < 0.05), respectively, after bubble CPAP was initiated. (PRE: before bubble CPAP initiation, POST: after bubble CPAP initiation, APP: advanced practice provider, NP: neonatal-perinatal, Res: pediatric resident, Other: respiratory therapist or registered nurse)
Percentage of endotracheal intubations performed per month by different provider types at Magee-Womens Hospital level 3 NICU before and after initiation of bubble CPAP.The percent of intubations performed by all provider types did not significantly change after bubble CPAP was introduced to the Magee-Womens Hospital NICU. (PRE: before bubble CPAP initiation, POST: after bubble CPAP initiation, APP: advanced practice provider, NP: neonatal-perinatal, Res: pediatric resident, Other: respiratory therapist or registered nurse)