586 - Prospective Identification of Intubation Competence in a Neonatology Fellowship Program

Poster Number: 586
Publication Number: 586.117

Elizabeth Foglia, Perelman School of Medicine at the University of Pennsylvania, Swarthmore, PA, United States; Matthew Devine, Childrens Hospital of Philadelphia, Collingswood, NJ, United States; Heather French, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States

Background: The ability to safely perform tracheal intubation (TI) is a fundamental skill for neonatal-perinatal medicine (NPM) fellows to acquire during fellowship. The ability to assess trainees’ procedural competence typically depends on individual NPM fellows accurately recording their performance in a procedure log. Self-reported procedure logs may both under and overestimate competence and provide insufficient real-time data on procedural performance to program leaders. 

Objective: To develop an electronic dashboard for a NPM fellowship program to accurately record intubation attempts and demonstrate real-time procedural competence for individual fellows

Design/Methods: Using data submitted to the National Emergency Airway Registry for Neonates (NEAR4NEOS), we prospectively collect data for TI encounters performed by NPM fellows (Table 1). Each fellow is assigned a unique ID number, and data associated with each intubation encounter are transferred from the NEARS4NEO registry to an electronic fellowship dashboard. Sequential intubation encounters are analyzed by cumulative sum (CUSUM) methodology. The competence threshold is defined as 70% success rate for TI encounters within 2 intubation attempts (ie: acceptable failure rate=30%). CUSUM curves for TI competence are generated for each NPM fellow and can be viewed in aggregate or stratified by procedural characteristics such as patient weight, use of paralytic premedication and video laryngoscopy (Figure 1). 

Results: Prospective TI data collected from the beginning of fellowship are available for all 19 NPM fellows in our training program. Cumulatively, 1st, 2nd, and 3rd year fellowship classes have attempted 35, 146, and 233 TI thus far, with a success rate of 90%, 82%, and 89% respectively (Table 2). Individual fellow dashboards allow fellowship leadership to personalize training needs and identify when remediation is needed (Figure 1). The sample fellow shown in Figure 1 demonstrated consistent TI success after 16 TI encounters and required >30 TI attempts to meet our competency threshold. Overall, our NPM fellows show higher TI success rates for encounters performed with paralytic premedication and video laryngoscope. More failures are associated with patient weight  < 1000 grams.  Conclusion(s): Gaining and maintaining competence in TI is critical for neonatal providers. A newly created electronic dashboard provides real-time, individualized data on evolving NPM fellow TI competence, allowing for early identification of fellows who need additional training to improve TI safety and success.  
Table 1Sample of Data Collected for Each Neonatal-Perinatal Fellow's Tracheal Intubation Encounters
Table 2Number of Total Tracheal Intubation Encounters, Attempts, and Success Rates By Fellowship Year