Talk Description
Introduction:
Difficult Airway encounters are a rare but dangerous event in Anaesthesia. Information regarding difficult airway management is often circulated via letters or found on other non-standardised documentation and may be difficult to obtain during the most critical moments, such as when performing a rapid sequence induction in the emergency department. At our institution, difficult airway documentation is entered within an "Alert" on our Electronic Medical Records (EMR) in a free-text field, but the quality and utility of these alerts was unknown. We set out to investigate the completeness and efficacy of Difficult Airway alerts in our centre and their impact on future airway management episodes, in the hope that we could aid in informing other institutions within Victoria and around Australia in their efforts to optimise difficult airway documentation.
Difficult Airway encounters are a rare but dangerous event in Anaesthesia. Information regarding difficult airway management is often circulated via letters or found on other non-standardised documentation and may be difficult to obtain during the most critical moments, such as when performing a rapid sequence induction in the emergency department. At our institution, difficult airway documentation is entered within an "Alert" on our Electronic Medical Records (EMR) in a free-text field, but the quality and utility of these alerts was unknown. We set out to investigate the completeness and efficacy of Difficult Airway alerts in our centre and their impact on future airway management episodes, in the hope that we could aid in informing other institutions within Victoria and around Australia in their efforts to optimise difficult airway documentation.
Design, Data Sources and Methods:
Patients who had a “Difficult Airway” entry on EMR from 2011 to 2021 were included. Each alert was analysed by a team of Anaesthetists with expertise in difficult airway management for its quality, appropriateness, and impact on future airway management episodes. This quality improvement project was granted ethical approval by the hospital’s ethics committee with a waiver of patient consent granted (RiskmanQ Number: 41033). No clinical trials registration was required for this study.
Patients who had a “Difficult Airway” entry on EMR from 2011 to 2021 were included. Each alert was analysed by a team of Anaesthetists with expertise in difficult airway management for its quality, appropriateness, and impact on future airway management episodes. This quality improvement project was granted ethical approval by the hospital’s ethics committee with a waiver of patient consent granted (RiskmanQ Number: 41033). No clinical trials registration was required for this study.
Results:
141 patients were included for this study, with a mean age of 58.6 +/- 15.3 years. Ninety-three (66%) alerts were created by medical staff, of which 52 were recorded by consultant Anaesthetists. 117 alerts (83%) were deemed to be appropriate by the airway expert team, but only 40 alerts (28%) were found to have sufficient quality to be helpful in emergent airway management. Sixty-five patients (47%) had at least one subsequent airway management episode, of which 35 patients (56%) underwent a change of management following alert creation. We proceeded to modify 103 alerts (73%) to improve their quality to aid future episodes.
141 patients were included for this study, with a mean age of 58.6 +/- 15.3 years. Ninety-three (66%) alerts were created by medical staff, of which 52 were recorded by consultant Anaesthetists. 117 alerts (83%) were deemed to be appropriate by the airway expert team, but only 40 alerts (28%) were found to have sufficient quality to be helpful in emergent airway management. Sixty-five patients (47%) had at least one subsequent airway management episode, of which 35 patients (56%) underwent a change of management following alert creation. We proceeded to modify 103 alerts (73%) to improve their quality to aid future episodes.
Discussion:
As initially hypothesised, most alerts were found to be appropriate but the majority lacked sufficient detail to be useful in an airway emergency. This reflects a critical deficiency in our institution's difficult airway documentation process. We identified four key barriers that may impede optimal difficult airway documentation in our centre, including
As initially hypothesised, most alerts were found to be appropriate but the majority lacked sufficient detail to be useful in an airway emergency. This reflects a critical deficiency in our institution's difficult airway documentation process. We identified four key barriers that may impede optimal difficult airway documentation in our centre, including
1. The lack of specific criteria for making a difficult airway alert
2. The paucity of guidelines for what information should be included in an alert
3. The deficit in staff training regarding creation and access of alerts
4. The current absence of a standardised statewide difficult airway documentation process
Following the identification of these factors, our institution has implemented a local version of the Queensland Health Difficult Airway Alert form and instituted an organisation-wide educational campaign to improve the appropriateness, consistency and ease of access to difficult airway documentation within our centre.
Conclusion: Difficult Airway encounters are an uncommon event in Anaesthesia, but clear, comprehensive and effectively communicated documentation is required to minimise the risk in future episodes. Despite our Institution’s sophisticated alert system, difficult Airway management remains poorly communicated. We have taken measures to improve local processes of difficult airway documentation and considered the implications of our project for the broader airway management community.
Conflicts of interest: N/A