Emergency Airway Management - the path to improved performance
Royal Flying Doctor Service Queensland, Edge Hill, Australia
Adam Pritchard (FACRRM, JCCA, DCH, PGCert Aeromed) is an Aeromedical Retrieval Specialist with the Royal Flying Doctor Service based in Cairns and Mt Isa, Medical Education Officer RFDS, Rural Generalist Mossman Hospital and Lifeflight Retrieval Doctor. He has worked in aeromedical retrieval, in both fixed wing and rotary wing operations since 2007.
Emergency Airway Management in the retrieval environment poses significant risks to critically unwell or injured patients. The challenges include:
- the inherent risk of sedation and paralysis;
- the physical environment including, access and difficult patient positioning;
- limited resources especially medication and equipment and importantly;
- crew resource issues including communication, planning and decision making.
Despite these difficulties, performance in Emergency Airway Management is one of the most significant and most conspicuous outcome measures upon which quality of care is measured. Below benchmark performance has significant implications for an organisation in terms of patient safety, contractual and funding obligations, and reputation. Based on the consideration of multiple workforce, procedural and organisational factors, RFDS QLD recognised this as a possible significant risk to the ongoing provision of critical care services for the next 30 years.
As such, a multifaceted organisational approach was taken to improving the provision of emergency airway management. These include the development and implementation of a standard operating procedure, changes to recruitment requirements, institution of daily RSI training, a review of airway equipment, structured training program, supervised practice, case audit, improved governance structure, and airway data collection and analysis.
We will present the process by which RFDS QLD has developed and implemented these changes, problems and barriers to implementation, as well as outcome data for the last 3 years of RFDS QLD emergency airway management. This demonstrates an improvement in performance in multiple areas, including overall success, first pass success and a decrease in complication rates.
The talk will cover the themes of quality and safety, system improvement, skills maintenance, performing under pressure, human factors, multi-tasking and decision making. It is a follow up to a poster presentation at the ASA conference Sydney 2017 "Standardising RSI: Introduction, Implementation, Outcomes?"