North West Airway Database

a reporting system that will enhance clinical performance in difficult airway management by gathering and disseminating cases from across the region.

You are called to A+E to manage a 19 year old male, picked up by ambulance following ejection from a car in a RTA. He arrives alert and anxious with difficulty breathing and stridor. What would you do?

How much clinical exposure have you had to patients with difficult airways?
How confident do you feel in managing patients with difficult airways?
How does inexperience in airway management impact on patients?

The advancement of airway skills beyond those needed for routine anaesthetic practice requires exposure to patients whose airways are challenging. However, the incidence of a difficult airway is relatively rare. Inadequate exposure due to a paucity of clinical cases is the primary barrier to skill and confidence development in airway management. A reduction in trainee hours caused by the implementation of EWTD compliant rotas compounds the problem further.

As trainees, our exposure to challenging and difficult airways is also influenced by:

hospital placements;
modules and lists we carry out whilst there;
consultants we work with;
available equipment; and
the chance of patients with truly difficult airways appearing.

Ultimately, our exposure is inconsistent and inadequate and there is a limit to what we can do to increase our direct clinical experiences.

 

Does exposure influence management?

Yes! Analysis of adverse events in airway management identifies inexperience, poor judgment, lack of education and training and an inability to manage complex cases as leading causes of patient morbidity and mortality. Delay and reluctance to perform necessary techniques contribute to adverse outcomes and the most common reason for avoidance of a technique is a lack of confidence.

Exposure and experience allow us to develop expertise in managing complex airways and avoid adverse events by increasing confidence, improving crisis management and enabling anaesthetists to recognise problems sooner and confidently start treatment in response to problems faster.

 

How can you increase your exposure to difficult airways?

Register at www.eanaesthesia.com/nwad using your GMC number and participate in the North West Airway Database (NWAD). Following registration, you will be granted access to the site, allowing you to submit cases and view others' cases. Participation will increase your exposure to difficult airways and you will even be rewarded with some valuable CPD points accredited by the RCOA!

 

How much time will it take to submit a case?

Not a lot! Your report to the database is a description of the case you encountered. The information included would be similar to that which you would relate to a colleague when describing the event to them.

Your report is intended to be non-onerous and anonymous in terms of hospital, reporter and patient. The majority of the information is narrative and you will describe in a sequential, chronological way what you believe relevant for others to be able to understand and learn from your case.

Include salient features of airway evaluation available from the history, systemic enquiry, examination or investigations.

Also include factors relevant to all parts of the airway management strategy for example, difficulties with bag-mask ventilation, supraglottic device placement, direct laryngoscopy and 'front of neck' techniques.

 

How can I access others' reports and benefit from their experience?

Your report once submitted, will be published online at www.eanaesthesia.com/nwad in the 'Case Reports' section and in a NWAD magazine circulated to anaesthetic departments throughout the region on a quarterly basis. As stated above, the report is anonymous in terms of the reporter. Anonymity is important to encourage reporting of both positive and negative experiences and to foster a culture of openness, enabling others to learn from the experience. We all know mistakes happen!

The NWAD magazine could be viewed in departmental coffee rooms throughout the region, encouraging us to focus on airway management by discussing the cases and consider what we may have done if presented with such a case. We do discuss cases within departments but in an ad-hoc way. Using the database enables everyone within the whole region to learn from each others' experience.

For attainment of high levels of performance, a commitment to sustained deliberate practice is required. By taking part, you will benefit from continual exposure to difficult airway cases, delivering career-long learning in airway management rather than focusing on training in discreet modules, enabling you to become a real expert!

 

How powerful can stories be?

As stated above the majority of your report is the narrative or 'story' of the case. Cases told in the form of a 'story' have a profound effect. More clinicians engage with them and as a result, they are more effective at driving learning and change than other forms of academic work such as traditional textbook or journal reading.

Submitting your airway management stories to be shared across the region has the potential to have a profound effect on our ability to manage airways. These stories hold further power as they make people realise the human impact of adverse events and thus provide a motive to seek to gain further expertise in the field.

 

How can 'stories' improve my performance in a crisis?

Protocols and algorithms are not easily referred to in one's mind when faced with a crisis situation. Mental representations built from our own and other's experiences are more easily and reliably recalled upon to steer us in the right direction. By increasing the wealth of experiences that participants can recall by taking part in the NWAD, we will all become more capable to manage these complex, infrequent occurrences and improve patient safety.

For more information or any questions please contact  clareconlon@doctors.org.uk.