592 - A Qualitative Study of the Effect of Environmental Distractors on Neonatal Endotracheal Intubation Skills

Poster Number: 592
Publication Number: 592.118

Lauren M. Miyares, Children's National Health System, WASHINGTON, DC, United States; Lamia Soghier, Children's National Health System, Washington, DC, United States

Background: Cognitive load theory identifies various aspects that are involved in completing a task. The dependent variable, extraneous cognitive load, includes distractions that interfere with processing new information. The neonatal intensive care unit (NICU) is a workplace where practitioners routinely complete tasks and process new information in a distracting environment. As such, it would seem most prudent to limit distractions to a minimum. The effect of auditory load on neonatal endotracheal intubations (ETI) has yet to be determined from a qualitative perspective.

Objective: To investigate the experience of participants with distractors, both auditory and others, in their everyday workplace and specifically during neonatal ETI.

Design/Methods: Nine participants experienced in endotracheal intubation (neonatal fellows) completed a cross-over cohort study where they were asked to intubate mannequins in four different scenarios: silence, classical music, alarms, silence. A 30-minute basic qualitative interview was conducted asking about participants’ experiences with performing NICU procedures, and distractors in the work environment. Interviews were recorded, deidentified, transcribed, and coded by investigators for common themes.

Results: Participants identified alarms and conversation as sources of noise. Most participants felt that they worked in a noisy environment (66%) and that noise should be decreased in the NICU (88%). Conversely, they did not name any type of visual distraction (66%). Others named olfactory distractors such as perfume. Few participants “tuned-out” noise when performing procedures (44%). Familiar procedures caused less performance pressure even in a noisy environment (66%). However, even the mere presence of people increased participants’ stress when performing a procedure such as ETI (55%). Finally, a few admitted that the patient’s acuity factored into their cognitive load when intubating (44%).Conclusion(s): Multiple types of distractions were identified and ranged from rare (perfume) to consistently present, i.e. loud conversations. Most participants agreed that the NICU is a noisy environment and efforts should be taken to decrease noise both for the patients’ and providers’ benefit. Tuning out noise while at work does raise the issue of alarm fatigue. The presence of an audience seems to be a more stressful factor than noise or other distractors. Limitations included a small sample size. Further directions include expanding the sample size and designing specific studies to further investigate alarm fatigue in the NICU setting.