Airway drills in the ED: Local innovation to increase skills and confidence in our regional department

Abstract

Background: We work in an increasingly busy regional Emergency Department. It is not uncommon for a patient to deteriorate requiring the efficient clinical skills and multidisciplinary collaboration to secure a patient’ s airway and support their breathing. Both medical and nursing staff have varying levels of experience in our department and working regionally creates additional challenges when caring for critically unwell patients, namely physical and staffing resources. We are also challenged regionally by the variability of presentations; we are the receiving hub for adults, paediatrics including neonates and at times for those so critically unwell they are brought to us to stabilise prior to retrieval. In the last twelve months we have intubated adult patients semi-regularly, three paediatric patients and two neonates. Critical cricothyroidotomies are so infrequent that we may never perform one in our career, but we need to be able to when called upon. The term coined to describe these, particularly the latter is ‘High Acuity, Low Occurrence ’ or ‘HALO’ events. HALO events can lead to cognitive overload and physiological stress responses for clinicians. Methods: Simulation is a corner stone of modern medical training and has been proven to accelerate skill acquisition, support mastering of procedures, decrease physiological stress and reduce errors in real time. Given the established efficacy of simulation, we set out to implement a daily airway drill. We involved key stakeholders to roll out a brief daily airway drill with varying presentation week by week: adult, paediatric, neonatal and critical airway. We circulated a pre implementation survey prior to the roll out and are currently collecting responses for our post implementation survey. Results: We identified that more than half of our department who responded lack confidence in intubating adult patients, and many clinicians feel not at all confident for intubating paediatric, neonatal or critical airways. All respondents felt participating in airway drills would improve their confidence and were interested in partaking in all above-mentioned drills. We have an eight-week post implementation survey released presently. Thus far 100% of responders have reported a growing confidence in their skills. We look forward to expanding on and sharing our findings with our colleagues at the SWH Research Day.