Audit of airway assessment and documentation for emergency patients at the Royal Derby Hospital
Various methods of airway assessment exist in order to enable prediction of the difficult airway, be it difficult direct laryngoscopy, difficult intubation or difficult mask ventilation . It is recognised that one method of assessment is insufficient to predict a difficult airway and a combination of tests should be used [2, 3]. This audit reviewed documentation of airway assessment for patients undergoing emergency surgery at the Royal Derby Hospital (RDH). This is typically a list with a high turnover of patients and anaesthetists, of varying experience, warranting high standards of documentation. Methods We retrospectively reviewed 50 anaesthesia charts of patients undergoing emergency surgical procedures from 12-29 January 2015. Audit standards were derived from a seminal paper by Calder . Criteria we included were: interdental distance, dental health, mandibular protrusion, neck movement, thyromental distance and Mallampati classification. The first three criteria were described as a minimum to constitute an appropriate airway assessment by Calder, but we accepted any three as the minimum standard. We also recorded which anaesthetist pre-operatively assessed the patient and whether the same practitioner went on to induce anaesthesia. Results Of the 50 anaesthesia charts, 25 documented interdental distance; two documented jaw protrusion and 37 documented dental health. Three charts documented all three nominated criteria. In total, 15 charts documented a minimum of three assessments of the six we were examining. As described in Table 1, eight charts showed no evidence of an airway assessment, and of these eight charts, five were completed by consultant anaesthetists, one by a specialist trainee and one by a core trainee. The assessor of the eighth chart was undetermined. Twenty six patients were assessed and anaesthetised by the same person. Discussion These data show that documentation of airway assessment at RDH is poor, with 50% of charts failing to demonstrate at least three assessments of the airway. The review by Calder describes how it would be indefensible to induce anaesthesia only to then discover the patient has an interdental distance of 2 cm, rendering insertion of a supraglottic airway rescue device extremely difficult. Following this audit we can make the following recommendations: (Table Presented) .