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Verbal Communication During Airway Management and Emergent Endotracheal Intubation: Observations of Team Behavior Among Multi-institutional Pediatric Intensive Care Unit In Situ Simulations

Rozenfeld, Ranna, A.*; Nannicelli, Anna, P.; Brown, Alexandra, R.; Eppich, Walter, J.‡§; Woods, Donna, M.; Lestrud, Steven, O.*; Noah, Zehava, L.*; Holl, Jane, L.†§

doi: 10.1097/PTS.0000000000000272
Original Article: PDF Only

Objective To assess health-care teams’ verbal communication, an observable teamwork behavior, during simulations involving pediatric emergency airway management and intubation.

Methods 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.

Results 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.

Conclusions 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; †Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University; and ‡Division of Emergency Medicine, §Department of Pediatrics, Feinberg School of Medicine, Northwestern University, and Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL.

Correspondence to: Ranna A. Rozenfeld, MD, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Avenue, Box 73 Chicago, IL (e-mail:

Financial Support: This work was funded by The Michael Reese Health Trust of Chicago, IL (to J.L.H. and D.M.W.). The larger in situ simulation study was funded by the Agency for Healthcare Research and Quality (R18-HS017909; to J.L.H) and The Michael Reese Health Trust.

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