Assessing the Efficacy of Difficult Airway Alerts in Electronic Medical Records: A Quality Improvement Study

Abstract

Study Design: Retrospective analysis of Difficult Airway alerts in a major tertiary centre. Objective: To investigate the completeness, utility and efficacy of Difficult Airway alerts and their impact on future airway management episodes. Design, Data Sources and Methods: Patients who had a “Difficult Airway” entry on Electronic Medical Records (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. 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. 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. Trial Registration: Not applicable