(1284) Impact of Digitization of Pediatric Airway Bundle Checklist on Adherence and Procedural Safety

Introduction: Pediatric Airway Bundle Checklist (ABC) has been shown to achieve high adherence and reduce adverse tracheal intubation associated events (TIAEs). We implemented a digital version of ABC that incorporates clinical decision support (CDS) for a safer procedural approach in a large academic PICU (75 beds). We hypothesize the digitization of ABC is associated with higher adherence (compliance, primary outcome) and lower TIAE and desaturation (SpO2 < 80%) rates.

Methods: The digitized ABC use was queried from the local server. We matched the checklist data with our local NEAR4KIDS QI database for the digital ABC use adherence and intubation outcomes. We also evaluated the frequency of the CDS used, teamwork issues, and quality improvement (QI) points reported from debriefing. Descriptive statistics and Fisher’s exact with p< 0.05 as significance.

Results: Between April 17th to June 30th, 2023, a total of 724 digital ABC risk assessment and planning were filled or updated for 473 patients. The commonly used CDS items included shock-fluid bolus and epinephrine preparation (n=243, 34%), respiratory failure with non-invasive support with LMA preparation (n=94, 39%), and history or features of difficult airway to review history, consider backup tools, and prepare skilled providers (n=59, 24%). 89 patients (19%) subsequently underwent tracheal intubation. The ABC use adherence was not changed: pre-digitization 80% (with partial completion 2%) vs. post-digitization 80% (partial completion 16%) in 2023, p=1.00. The TIAE rate was similar: pre-digitization 7.5% vs. post-implementation 4.5%, p=0.414, and desaturation rate (SpO2 < 80%) was significantly different: pre-digitization 15.0% vs. post-digitization 4.5%, p=0.015. Overall team performance, teamwork, and communication were rated high (median 5, 1-5 Likert scale). Commonly identified QI points include equipment issues (n=12/72, 17%), overcrowding (n=4, 6%), medication administration (n=4, 6%), and understaffing (n=2).

Conclusions: A paper-based airway bundle checklist was successfully converted to digital format. The digitization of ABC was not associated with higher adherence or lower TIAE, but it was associated with oxygen desaturation rate during the short observation period. The digital documentation identified common QI issues.