Acute Management of Complex Airway Emergencies on a Respiratory High Dependency Unit

J.Mayer, C. Hayden, V. Haile

Introduction:

Complex airway problems are life-threatening emergencies affecting up to 30% of tracheostomy patients(1), where initial management leads to identifiable harm in up to 75% of cases(2). Such situations are increasing in prevalence and recent initiatives stress the importance of guidelines and training (1). However, junior medics working on the respiratory high-dependency unit felt ill-equipped to manage these situations with 56% surveyed never receiving any training throughout their career. This poses significant risk to patient safety, particularly at a time when nursing ratios are stretched.

Aims:

To improve Medics’:

-Self-rated ability in managing complex airway emergencies (primary).

-Self-rated confidence in managing complex airway emergencies (secondary).

-Knowledge of complex airways and associated problems (secondary).

PDSA Cycles

Baseline data were collected via survey to respiratory juniors.

PDSA cycle interventions were as follows:

1.Teaching presentation during the respiratory educational meeting.

2.Simulation training with the respiratory physiotherapists.

3.Tracheostomy model in the respiratory doctor's office.

4.Addition of information poster's and "test yourself" materials alongside the tracheostomy model (in progress).

Follow-up data collection was carried out throughout the PDSA cycles via random sampling. The participants were asked to rate their ability and confidence from 1 - 10. The mean value was taken for comparison. This was followed by three knowledge based, multiple-choice questions. The percentage of participants who have scored 3 out of 3 has been used for comparison between cycles.

Presentation Simulation

Tracheostomy Model

Previous Complex Airway Teaching:

Posters and ”Test

Driver Diagram

Balancing measures: -Incident form -Knowledge compared to confidence and ability.

Results:

Confidence

Ability

Knowledge

Lessons Learnt and Moving Forward

By providing teaching, simulation sessions and easy access to educational materials, the junior medical team's ability, confidence and knowledge in managing complex airway emergencies has improved. This project highlights the value of training and education, particularly regarding a subject that is not consistently taught throughout undergraduate or postgraduate training. By improving the medical team's ability in managing complex airway emergencies, we minimise the risk to patient safety.

This project is ongoing with the fourth PDSA cycle currently underway. We are hopeful that we will be able to arrange teaching and simulation sessions at the start of new junior doctor rotations.

References: 1. McGrath BA, Wallace S, Lynch J, Bonvento B, Coe B, Owen A, Firn M, Brenner MJ, Edwards E, Finch TL, Cameron T. Improving tracheostomy care in the United Kingdom: results of a guided quality improvement programme in 20 diverse hospitals. British journal of anaesthesia. 2020 Jul 1;125(1):e119-29. 2. McGrath BA, Thomas AN. Patient safety incidents associated with tracheostomies occurring in hospital wards: a review of reports to the UK National Patient Safety Agency. Postgraduate medical journal 2010;86(1019):522-5. Epub 2010/08/17