Development and Validation of the Denver Critical Illness Intubation Entrustment (D-CITE) Tool

Background: ICU intubations are high-risk procedures requiring technical and cognitive skills. Training in ICU intubations varies; no validated tools exist to assess intubation skills for the adult ICU setting. We sought to develop and validate an ICU intubation entrustment tool. Research Question: Is a novel entrustment-based assessment tool valid to assess adult ICU intubation skill? Study Design and Methods: We conducted a modified Delphi study consisting of multidisciplinary intubation education experts to identify relevant skills. After development of the tool, we applied the tool in a simulation setting to gather further validity evidence. During the simulation, participants completed 3 intubation scenarios and were evaluated by at least 2 raters. We assessed reliability using Cronbach α and interclass correlation, and conducted exploratory factor analysis and Rasch modeling to assess internal structure validity. Results: The modified Delphi study included 19 experts representing 17 institutions and consisted of 2 rounds. The study resulted in the Denver Critical Illness Intubation Entrustment (D-CITE) Tool, containing 10 intubation microskills, a global entrustment assessment, and objective classifications of intubation difficulty. Twenty participants completed the simulation, including 8 beginner participants (0-5 prior intubations), 7 intermediate participants (5-25 prior intubations), and 5 advanced participants (> 100 prior intubations). The D-CITE tool demonstrated high reliability with a Cronbach alpha of 0.97 (95% CI, 0.969-0.981), and an interclass correlation of 0.77 (95% CI, 0.754-0.786). Exploratory factor analysis identified a single factor, signifying that the D-CITE tool evaluates intubation competency as a single construct. Rasch modeling demonstrated appropriate model fit (infit mean square ± SD, 0.99 ± 0.05; outfit mean square ± SD, 0.96 ± 0.06). Interpretation: We created a novel intubation entrustment tool and gathered validity evidence to support its use for evaluating trainee progress toward competence in a simulated environment. Future studies will assess validity for use during real-world intubations.