Abstract Rationale Intensive Care Unit (ICU) intubations are high-risk procedures. Training in ICU intubations varies, and there are no validated tools to assess intubation skills in the adult ICU setting. Existing tools commonly rely on checklist approaches of assessment and fail to capture the nuances of the continuum of competency. We sought to develop and validate a novel ICU intubation entrustment tool. Methods We conducted a modified Delphi study including intubation education experts in Anesthesia, Emergency Medicine, and Pulmonary/Critical Care Medicine. Following the development of the tool, we conducted two simulation sessions to gather further validity evidence. Three simulated airway management scenarios were completed by three groups of participants: beginners (0-5 prior intubations), intermediate (5-25 prior intubations), and advanced (100 prior intubations). Simulations were assessed by at least two faculty. Following the simulation, faculty completed a survey and interview about their experience. We calculated Cronbach’s alpha and intraclass correlation to assess reliability and conducted exploratory factor analysis and Rasch modeling to further assess structural validity. Results The modified Delphi study included nineteen experts representing seventeen institutions and consisted of two rounds. The process resulted in the Denver Critical Illness Intubation Entrustment (D-CITE) Tool, which contains ten intubation micro-skills (e.g., assessing for potential anatomic difficulty, passing the endotracheal tube), a global entrustment assessment, and object classifications of intubation difficulty (e.g., anatomically difficult, physiologically difficult). Each intubation micro-skill is rated on a five-point entrustment scale, from “I need to perform the procedure with the trainee observing” to “I do not need to be there”. Twenty-nine participants completed the simulation scenarios. Validity evidence arranged by Messick’s Unified Validity Framework is summarized in Table 1. The D-CITE tool demonstrated high reliability with Cronbach’s alpha of 0.97 and intraclass correlation of 0.77. Exploratory factor analysis demonstrated a single factor of intubation competence. Six of ten faculty completed the post-simulation survey, all of whom strongly agreed or agreed that 1) they understood what the tool was asking, 2) the tool would help them give formative feedback to trainees, 3) they were able to easily complete the tool on their phones, and 4) they would have time to complete the tool in the clinical environment. Conclusion The authors created a novel adult ICU intubation entrustment tool and gathered validity evidence to support its use in a simulated environment. Future studies will evaluate the tool’s validity for use to evaluate real-world intubations. This abstract is funded by: None
Wykowski et al. (Fri,) studied this question.