Significant benefits have been demonstrated with the use of peri-operative checklists. We assessed whether a read-aloud didactic action card would improve performance of cannula cricothyroidotomy in a simulated 'can't intubate, can't oxygenate' scenario. A 17-step action card was devised by an expert panel. Participants in their first 4 years of anaesthetic training were randomly assigned into 'no-card' or 'card' groups. Scenarios were video-recorded for analysis. Fifty-three participants (27 no-card and 26 card) completed the scenario. The number of steps omitted was mean (SD) 6.7 (2.0) in the no-card group vs. 0.3 (0.5); p < 0.001 in the card group, but the no-card group was faster to oxygenation by mean (95% CI) 35.4 (6.6-64.2) s. The Kappa statistic was 0.84 (0.73-0.95). Our study demonstrated that action cards are beneficial in achieving successful front-of-neck access using a cannula cricothyroidotomy technique. Further investigation is required to determine this tool's effectiveness in other front-of-neck access situations, and its role in teaching or clinical management.

Purpose -The purpose of this paper is to compare and contrast traditional data collection methodologies employed in health care with more practical observational methods which are closely aligned with Lean thinking. When combined with problem solving, observational approaches achieve demonstrable improvements in clinical outcomes, productivity and efficiency. The paper aims to describe the changes in mindset and behaviour that are required to adopt the observational methods. Design/methodology/approach -The approach is to describe and evaluate case study examples on the use of observational data in the National Health Service in the UK. This is then used to derive generic principles about the wider application of observational data in health care. Findings -Traditional data collection methodologies are often insufficient to expose the root cause of a problem and therefore may result in little or no action. The observational methods identify the root cause and as such offer a much more practical and real-time way of solving process-related problems. Practical implications -The observational methods of collecting data described here offer staff at all levels of the organisation practical approaches to preventing mistakes and errors in health care processes. Originality/value -The case studies described here support the reintroduction of observational techniques used by the early pioneers of productivity. The originality of the paper is in the use of these observational methods in a wide range of clinical settings to provoke changes in working practices.

We believe that improved task efficiency and insight into the challenges of the ward round gained by medical students will lead to an enhancement in performance during clinical rounds, and will have a positive impact on patient safety. We would suggest that undergraduate medical schools consider this model in the preparation for the clinical practice element of the curriculum.

In a large Denver HMO, a retrospective study of asthma management was reviewed. Seventy moderate to severe asthmatic patients' charts were reviewed through April 1994. All patients admitted to the study had to be followed for at least 1 year by a primary care physician before the allergy evaluation (AE) and for at least one year of followup (F/U) after the AE. All patients had at least two acute care (ER) visits and/or one hospitalization before the AE. All primary care, AE, and F/U were done by staff physicians in the Kaiser Permanente system. The findings included 1) Forty-five percent decrease (308 to 169) in the number of sick care office visits (P = 0.0001); 2) fifty-five percent decrease (266 to 118) in acute care visits (P = 0.0001); 3) sixty-seven percent decrease (34 to 11) in the number of hospitalizations after the AE (P = 0.001); 4) average hospital days before AE were four days and after AE, 2.5 days; 5) estimated cost saving of $145,500, or $2,100 per patient.

Summary Background Addressing themes raised by the Royal College of Anaesthetists National Audit Project 4, we introduced new training programmes to improve the knowledge and skills necessary for the management of airway crises. A further large‐scale multimodal training programme was introduced to implement guidelines published in 2015 by the Difficult Airway Society (DAS). Methods In 2014, questionnaires were used to assess the knowledge necessary to manage the unanticipated difficult airway before and after high‐fidelity simulation sessions. In 2016, surveys assessed knowledge of new DAS guidelines before and 5 months after the implementation of a large‐scale targeted teaching programme to educate staff. Results In 2014, 20 anaesthetic teams (75 delegates) attended high‐fidelity simulations and demonstrated a significant immediate improvement in knowledge. In 2016, 185 participants attended a targeted teaching programme. Although after the teaching programme an increased number of anaesthetists reported having accessed training, there was a persistent knowledge gap, with some details retained by as few as 15% of participants. Discussion Whereas the knowledge of these important guidelines was improved in the immediate aftermath of high‐fidelity simulation training, the knowledge retention was disappointing, raising questions as to why knowledge of highly important techniques used in crises was so poor. We ask whether training should be compulsory and how knowledge retention might be improved across all health care disciplines that rely on guidelines for the effective management of rarely occurring but safety‐critical events.