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 “d...
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| Language: | English |
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2024-10-01
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| Series: | BMC Anesthesiology |
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| Online Access: | https://doi.org/10.1186/s12871-024-02747-8 |
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| author | Wen-Shen Lee Luke R. Fletcher Shervin Tosif Timothy Makar Jon M. Graham |
| author_facet | Wen-Shen Lee Luke R. Fletcher Shervin Tosif Timothy Makar Jon M. Graham |
| author_sort | Wen-Shen Lee |
| collection | DOAJ |
| description | 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 analyzed by a team of anesthetists with expertise in difficult airway management for its quality, appropriateness, and impact on future airway management episodes. Alert quality was defined as to whether the content of the alert contained pertinent information for emergent airway management. Alert appropriateness was defined as to whether the experts would be unhappy to perform a rapid sequence induction and intubation, if required, following review of all available documentation. 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 anesthetists. 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 encounters. Conclusion Difficult Airway encounters are an uncommon event in anesthesia, but clear, comprehensive and effectively communicated documentation is required to minimize the risk in future encounters. In our institution, while most difficult airway alerts were appropriate, we found significant heterogeneity in the quality of this documentation, which limits the clinical utility of the alert system. 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. |
| format | Article |
| id | doaj-art-efd9b03a0dcf4ebea9b3a07b0a9be8be |
| institution | OA Journals |
| issn | 1471-2253 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj-art-efd9b03a0dcf4ebea9b3a07b0a9be8be2025-08-20T02:11:49ZengBMCBMC Anesthesiology1471-22532024-10-012411910.1186/s12871-024-02747-8Assessing the efficacy of difficult airway alerts in electronic medical records: a quality improvement studyWen-Shen Lee0Luke R. Fletcher1Shervin Tosif2Timothy Makar3Jon M. Graham4Department of Anaesthesia, Austin HospitalDepartment of Anaesthesia, Austin HospitalDepartment of Anaesthesia, Austin HospitalDepartment of Anaesthesia, Austin HospitalDepartment of Anaesthesia, Austin HospitalAbstract 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 analyzed by a team of anesthetists with expertise in difficult airway management for its quality, appropriateness, and impact on future airway management episodes. Alert quality was defined as to whether the content of the alert contained pertinent information for emergent airway management. Alert appropriateness was defined as to whether the experts would be unhappy to perform a rapid sequence induction and intubation, if required, following review of all available documentation. 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 anesthetists. 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 encounters. Conclusion Difficult Airway encounters are an uncommon event in anesthesia, but clear, comprehensive and effectively communicated documentation is required to minimize the risk in future encounters. In our institution, while most difficult airway alerts were appropriate, we found significant heterogeneity in the quality of this documentation, which limits the clinical utility of the alert system. 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.https://doi.org/10.1186/s12871-024-02747-8Difficult airwayIntubationQuality improvement |
| spellingShingle | Wen-Shen Lee Luke R. Fletcher Shervin Tosif Timothy Makar Jon M. Graham Assessing the efficacy of difficult airway alerts in electronic medical records: a quality improvement study BMC Anesthesiology Difficult airway Intubation Quality improvement |
| title | Assessing the efficacy of difficult airway alerts in electronic medical records: a quality improvement study |
| title_full | Assessing the efficacy of difficult airway alerts in electronic medical records: a quality improvement study |
| title_fullStr | Assessing the efficacy of difficult airway alerts in electronic medical records: a quality improvement study |
| title_full_unstemmed | Assessing the efficacy of difficult airway alerts in electronic medical records: a quality improvement study |
| title_short | Assessing the efficacy of difficult airway alerts in electronic medical records: a quality improvement study |
| title_sort | assessing the efficacy of difficult airway alerts in electronic medical records a quality improvement study |
| topic | Difficult airway Intubation Quality improvement |
| url | https://doi.org/10.1186/s12871-024-02747-8 |
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