Videographic Assessment of Preintubation Checklist Use in Pediatric Emergency Departments: A NEAR4PEM Checklist...

Cognitive aids are widely used in pediatric emergency departments (PEDs), yet real-world use is difficult to assess via self-report or the medical record. We used video review to assess whether (adoption) and how (fidelity) the NEAR4PEM Preintubation Checklist was used during tracheal intubations (TIs) in PEDs.

Prospective observational study at 2 tertiary PEDs with continuous multivideo camera recording in resuscitative areas. Four independent reviewers used a standardized video abstraction tool to evaluate checklist use in checklist item verbalization, completion, timing, and efficiency (time spent on the checklist).

Among 47 TIs, the checklist was used in 34 (72%). Thirty (88%) cases (22 medical, 8 trauma) were available for video review. Inter-reviewer concordance on all data elements was 96%. Verbalization of all 26 checklist items occurred in only 10% of cases. For most items, verbalization occurred in >80% of TIs and completion in ≥70%. Lower rates were observed for "limit on attempts/duration discussed" (verbalized in 33%, completed in 23%) and for "rescue devices identified/prepared" (verbalized in 63%, completed in 47%). Several preparation and equipment tasks were typically completed before checklist verbalization, whereas anticipatory-planning elements-such as difficult airway considerations, limits on attempts, and postintubation planning-were more often addressed after checklist prompting. Median checklist completion time was 2 minutes (IQR: 1 to 3min). Reviewers reported that the checklist was used effectively for patient preparation and enhanced team communication in 28 cases (93%).

While checklist adoption was high, checklist item completion varied widely, potentially highlighting which elements function as true cognitive aids versus those reflecting routine practice. Video review provides a feasible and uniquely informative method to measure real-world implementation and identify opportunities to improve ED cognitive aid use.