Usability Testing Via Simulation: Optimizing the NEAR4PEM Preintubation Checklist With a Human Factors Approach

Area of Science:

• Pediatric Emergency Medicine
• Human Factors Engineering
• Patient Safety

Background:

• Developing effective preintubation checklists is crucial for pediatric emergency care.
• Previous methods identified essential checklist content via a modified Delphi approach.

Purpose of the Study:

• To inform the development of a preintubation checklist for pediatric emergency departments.
• To conduct multicenter usability testing of a prototype checklist using simulation.

Main Methods:

• Prospective, mixed-methods study across 7 sites in the National Emergency Airway Registry for Pediatric Emergency Medicine (NEAR4PEM) collaborative.
• Pediatric emergency medicine physicians and fellows participated in simulated "easy" and "difficult" airway scenarios.
• Usability data were collected via surveys, structured debriefings, and qualitative analysis, informed by human factors principles.

Main Results:

• The prototype checklist was found helpful, easy to use, clear, and appropriately lengthy by 55 participants.
• During simulations, 93% of checklist items were verbalized and over 80% completed, with median completion times under 7 minutes.
• Key strengths included facilitating shared mental models, offloading cognitive load, and prompting contingency planning; suggestions focused on item clarity and customization.

Conclusions:

• Simulation-based, human factors usability testing effectively optimized the NEAR4PEM Preintubation Checklist before clinical implementation.
• Future steps involve real-world implementation using rigorous strategies and evaluating patient outcomes and safety.
• The study highlights the importance of usability testing and human factors in developing critical medical tools.