High-risk simulation to assess the usability of digitized airway bundle checklist in the picu

Introduction: The Airway Bundle Checklist (ABC) has been shown to improve tracheal intubation (TI) safety outcomes. ABC contains three sections performed by the bedside staff: pre-planning, pre-procedure timeout, and post-procedure huddle. We developed a ‘smart’ digitized ABC that provides specific recommendations based on risk factors. We hypothesized team leader’s cognitive task load with digitized ABC use would be different from current paper-based ABC in a realistic PICU interdisciplinary simulation based on real high-risk TIs. Methods: The digitized ABC was developed by translating the paper checklist and incorporating clinician inputs. A short training video showing how to use the digital checklist was shared with participants before simulation. Two realistic TI scenarios modified from clinical cases with adverse events were run for 5-10 min each with interdisciplinary ICU team (RT, RN, physician/advanced practice provider, APP). Each team was randomized to the order of the scenario and the type of the checklist. The APP, Fellow, or Attending who used the checklist reported cognitive task load (NASA TLX) and assessed the usability of the digitized checklist using a brief survey with 5-point Likert scale [1=disagree to 5=agree]. Paired t-test. Results: 23 RTs, 25 RNs, 4 APPs, and 16 Fellows/Attendings participated in 20 interdisciplinary simulations. No differences were found in the NASA TLX between the digitized vs. paper checklist [43±12 vs. 44±9, p=0.903, t=-0.12, paired t-test]. No significant effect of the order [t=1.87, p=0.092] or the type of scenario [t=2.01. p=0.072] was observed. Usability assessment showed (1) various functions of the digitized checklist were well integrated [3.7±1.0], (2) documenting team feedback was easy [3.9±1.0], (3) providers felt prepared to provide care with the digitized checklist [4.3±0.9], and (4) providers were able to achieve care goals [4.5±0.6]. Qualitative comments suggested to consider the checklist-workflow integration, clickable checkboxes, and barriers to using a tablet with gloves. Conclusions: In simulation-based testing of the digitized ABC with interdisciplinary team, team leader did not report higher cognitive taskload and felt positive about the checklist usability.