Improving Intubation Readiness: A Quality Improvement Project

Tuesday, March 24, 2026

8:45 AM - 9:45 AM Central Time

Location: Connections Central - RST 10

AJ

Amy Joseph, MD

Cleveland Clinic Children's Hospital

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

Kelly Pompey, RN

Pediatric ICU Nurse
Cleveland Clinic Children's

Disclosure information not submitted.
KT

Kelly Traul, RN, CCRN

Pediatric ICU Nurse
Cleveland Clinic Children's

Disclosure information not submitted.
JH

Jessica Hoang, APRN, CPNP-AC/PC

Pediatric Critical Care Nurse Practitioner
Cleveland Clinic Children's

Disclosure information not submitted.
KF

Kathy Fedor, n/a

Manager, Pediatric Respiratory Therapy
Cleveland Clinic Children's, Ohio

Disclosure information not submitted.
NS

Nicole Saliba, n/a

Supervisor, Pediatric Respiratory Therapy
Cleveland Clinic Children's, Ohio

Disclosure information not submitted.
AJ

Angela Jarden, MSN, RN, CCRN

Program Director Devices & Circulatory Support
Cleveland Clinic Children's

Disclosure information not submitted.
CA

Catherine Allan, MD

Pediatric Intensivist
Cleveland Clinic Children's

Disclosure information not submitted.
WH

Will Hanna, MD

Fellowship Program Director, Pediatric Critical Care Medicine
Cleveland Clinic, Ohio

Disclosure information not submitted.
AG

Anjali Gupta, MD

Assistant Professor
Cleveland Clinic Children's

Disclosure information not submitted.

Introduction: Intubation is frequently performed in the pediatric and cardiac intensive care units (PICU and PCICU), with the potential for complications if not executed precisely. Ensuring the multidisciplinary team feels adequately prepared is essential for optimal patient outcomes. Baseline surveys of our team revealed gaps in intubation preparedness, prompting the development of a quality improvement initiative aimed at enhancing readiness for intubation procedures in our PICU and PCICU.

Methods: We established the Intubation Readiness Group with PICU and PCICU stakeholders, including attendings, fellows, advanced practice providers, nurses, and respiratory therapists. To assess baseline perceptions regarding intubation readiness, timeliness, and areas for improvement, we distributed a survey to all team members. Based on the survey findings, the group identified strategies to enhance readiness. Our first intervention was the introduction of a pre-admission huddle to raise awareness among the team of potential intubation needs before patient arrival. We then implemented an intubation checklist to be used immediately before each procedure, ensuring standardized preparation of supplies and monitoring. Education was provided for all team members before introducing each checklist. Weekly reminders and monthly email notifications reinforced checklist usage. Quarterly surveys were conducted to track progress in intubation readiness over time.

Results: The huddle checklist was utilized in 72% of applicable cases. The intubation checklist was used in 77% of intubations, with the primary reason for non-use being the emergent nature of the procedure. Serial surveys indicated an improvement in perceived intubation readiness, with the average Likert score on a 5-point scale rising from 4.0 to 4.5. The perceived time from decision to intubation remained consistent at 10-30 minutes throughout the study period, with no increase following implementation of the checklist.

Conclusions: In conclusion, the implementation of two checklists in our PICU and PCICU enhanced overall intubation readiness without increasing time for the procedure. Future steps will focus on expanding team education around the intubation process and incorporating multidisciplinary in-situ simulations to increase team confidence and preparedness.