Verbal Communication During Airway Management and Emergent Endotracheal Intubation: Observations of Team Behavior Among Multi-institutional Pediatric Intensive Care Unit In Situ Simulations.
To assess health-care teams' verbal communication, an observable teamwork behavior, during simulations involving pediatric emergency airway management and intubation.



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.



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.



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.
From the Division of Critical Care Medicine, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, and Ann & Robert H. Lurie Children's Hospital of Chicago.
Ranna A
RA
Rozenfeld
Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University.
Anna P
AP
Nannicelli
Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University.
Alexandra R
AR
Brown
Walter J
WJ
Eppich
Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University.
Donna M
DM
Woods
From the Division of Critical Care Medicine, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, and Ann & Robert H. Lurie Children's Hospital of Chicago.
Steven O
SO
Lestrud
From the Division of Critical Care Medicine, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, and Ann & Robert H. Lurie Children's Hospital of Chicago.
Zehava L
ZL
Noah
Jane L
JL
Holl
D000293:Adolescent; D058109:Airway Management / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003142:Communication; D005260:Female; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000592:standards*; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D010348:Patient Care Team / Q000592:standards*