Introduction: Tracheal intubation (TI) checklist use reduces adverse TI associated events (TIAE). Team leader’s taskload and bedside teamwork may be important factors for successful TIs in the Pediatric ICU. We collected both team leader’s taskload and objective teamwork assessment during prior to implementation of a new digitized checklist replacing the traditional paper checklist. We hypothesized the leader’s self-rated taskload and teamwork assessed by senior nursing/respiratory staff were both associated with occurrence of adverse airway outcomes: AAOs (TIAE and/or hypoxemia< 80%). Methods: From 10/2023-6/2025, we prospectively implemented a team leader’s taskload assessment for TI in 6 PICUs. A teamwork assessment was also completed by senior nurse or respiratory therapists using a previously validated NEAR4KIDS teamwork scale (1-5, 5=best), with an updated training tool for standardization. After TI, each leader self-reported their taskload using NASA-TLX and a senior member recorded teamwork. TI outcome was collected using the NEAR4KIDS data collection tool. Wilcoxon rank-sum compared scores between TIs with vs without AAOs. We evaluated the association between leader’s taskload and teamwork using Spearman’s correlation. Results: A total of 170 TIs had either leader taskload or teamwork (Both completed 66, taskload only 48, teamwork only 56). Among 170 TIs, 39 (23%) experienced AAOs. There was no difference in leader taskload: TI with AAO median 50 IQR 46-57 vs without 46 37-56, p=0.397. There was significant difference in teamwork: TI with AAO median 4 3.4-5 vs without 5 4-5, p=0.009. There was a negative correlation between leader taskload and teamwork (Spearman’s rho=-0.32, p=0.0068). In the taskload subscale, performance was high (median 83), while physical demand and frustration were low (26.5, 27.5). Teamwork score subscales were consistently high (all median 5). Conclusions: Across 6 PICUs using a traditional TI checklist, self-reported leader’s taskload was moderate-high. There was significant difference between TIs with AAO vs. without, while direction of causal relationship is unclear. With the implementation of a digitized TI checklist incorporating decision support and prediction-based alerts, we will prospectively evaluate changes in the leader’s taskload and bedside teamwork.
Mai et al. (Sun,) studied this question.