Team Leader's Taskload, Teamwork, and Intubation Outcomes in 6 PICUs

Sunday, March 22, 2026

12:15 PM - 1:15 PM Central Time

Location: Connections Central - RST 12

MM

Mark Mai, MD, MHS

Children's Healthcare of Atlanta/Emory University

Disclosure(s): No relevant financial relationship(s) to disclose.
MA

Michelle Adu-Darko, MD

Associate Professor of Pediatrics
University of Virginia

Disclosure information not submitted.
AT

Andrea Talukdar, MD

Assistant Professor of Pediatrics
University of Nebraska Medical Center

Disclosure information not submitted.
RS

Ronald Sanders, MD, MS, FCCM

Professor of Pediatrics, Section of Critical Care, Department of Pediatrics
Arkansas Childrens Hospital

Disclosure information not submitted.
CP

Christopher Page-Goertz, MD

Program Director, Clinical Research and Outcomes, Associate Professor of Pediatrics
Akron Childrens Hospital

Disclosure information not submitted.
VN

Vinay Nadkarni, MD, MS, FCCM

University of Pennsylvania Perelman School of Medicine

Disclosure information not submitted.
JT

Jeritt Thayer, PhD

Assistant Professor, Department of Pediatrics
University of Pennsylvania Perelman School of Medicine

Disclosure information not submitted.
RG

Robert Grundmeier, MD

Professor of Pediatrics
University of Pennsylvania Perelman School of Medicine

Disclosure information not submitted.
KC

Kenneth Catchpole, PhD

Professor, Anesthesia and Perioperative Medicine
Medical University of South Carolina

Disclosure information not submitted.
Akira Nishisaki, MD, MSCE (he/him/his)

Childrens Hospital of Philadelphia, Pennsylvania

Disclosure information not submitted.

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.