Effect of Simulation Training on Compliance with Difficult Airway Management Algorithms, Technical Ability, and Skills Retention for Emergency Cricothyrotomy

2014 ◽  
Vol 120 (4) ◽  
pp. 999-1008 ◽  
Author(s):  
Vincent Hubert ◽  
Antoine Duwat ◽  
Romain Deransy ◽  
Yazine Mahjoub ◽  
Hervé Dupont
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Rating Scale ◽  
Global Rating Scale ◽  
Global Rating ◽  
Difficult Airway Management ◽  
Management Guidelines ◽  
Checklist Score ◽  
Skills Retention ◽  
The Impact

Abstract Background: The effectiveness of simulation is rarely evaluated. The aim of this study was to assess the impact of a short training course on the ability of anesthesiology residents to comply with current difficult airway management guidelines. Methods: Twenty-seven third-year anesthesiology residents were assessed on a simulator in a “can’t intubate, can’t ventilate” scenario before the training (the pretest) and then randomly 3, 6, or 12 months after training (the posttest). The scenario was built so that the resident was prompted to perform a cricothyrotomy. Compliance with airway management guidelines and the cricothyrotomy’s duration and technical quality were assessed as a checklist score [0 to 10] and a global rating scale [7 to 35]. Results: After training, all 27 residents (100%) complied with the airway management guidelines, compared with 17 (63%) in the pretest (P < 0.005). In the pretest and the 3-, 6-, and 12-month posttests, the median [range] duration of cricothyrotomy was respectively 117 s [70 to 184], 69 s [43 to 97], 52 s [43 to 76], and 62 s [43 to 74] (P < 0.0001 vs. in the pretest), the median [range] checklist score was 3 [0 to 7], 10 [8 to 10], 9 [6 to 10], and 9 [4 to 10] (P < 0.0001 vs. in the pretest) and the median [range] global rating scale was 12 [7 to 22], 30 [20 to 35], 33 [23 to 35], and 31 [18 to 33] (P < 0.0001 vs. in the pretest). There were no significant differences between performance levels achieved in the 3-, 6-, and 12-month posttests. Conclusion: The training session significantly improved the residents’ compliance with guidelines and their performance of cricothyrotomy.

Interprofessional simulation training in difficult airway management: a narrative review

2020 ◽  
Vol 29 (1) ◽  
pp. 36-43 ◽  
Author(s):  
Maria Coyle ◽  
Daphne Martin ◽  
Karen McCutcheon
Keyword(s):  
Literature Review ◽  
Airway Management ◽  
Difficult Airway ◽  
Patient Outcomes ◽  
Simulation Training ◽  
Vital Role ◽  
Difficult Airway Management ◽  
Narrative Literature ◽  
Narrative Literature Review ◽  
The Impact

The aim of this narrative literature review was to explore the impact of interprofessional simulation-based team training on difficult airway management. The Fourth National Audit Project of The Royal College of Anaesthetists and The Difficult Airway Society identified recurrent deficits in practice that included delayed recognition of critical events, inadequate provision of appropriately trained staff and poor collaboration and communication strategies between teams. Computerised databases were assessed to enable data collection, and a narrative literature review and synthesis of eight quantitative studies were performed. Four core themes were identified: debriefing, measures of assessment and evaluation, non-technical skills and patient safety, and patient outcomes. There are many benefits to be gained from interprofessional simulation training as a method of teaching high-risk and infrequent clinical airway emergencies. The practised response to emergency algorithms is crucial and plays a vital role in the reduction of errors and adverse patient outcomes.

scholarly journals Unanticipated Difficult Airway in Obstetric Patients

2012 ◽  
Vol 117 (4) ◽  
pp. 883-897 ◽  
Author(s):  
Mrinalini Balki ◽  
Mary Ellen Cooke ◽  
Susan Dunington ◽  
Aliya Salman ◽  
Eric Goldszmidt
Keyword(s):  
Cesarean Section ◽  
Difficult Airway ◽  
Rating Scale ◽  
Fetal Distress ◽  
Maternal Distress ◽  
Global Rating Scale ◽  
High Fidelity ◽  
Global Rating ◽  
High Fidelity Simulation ◽  
Emergency Cesarean

Background The objective of this study was to develop a consensus-based algorithm for the management of the unanticipated difficult airway in obstetrics, and to use this algorithm for the assessment of anesthesia residents' performance during high-fidelity simulation. Methods An algorithm for unanticipated difficult airway in obstetrics, outlining the management of six generic clinical situations of "can and cannot ventilate" possibilities in three clinical contexts: elective cesarean section, emergency cesarean section for fetal distress, and emergency cesarean section for maternal distress, was used to create a critical skills checklist. The authors used four of these scenarios for high-fidelity simulation for residents. Their critical and crisis resource management skills were assessed independently by three raters using their checklist and the Ottawa Global rating scale. Results Sixteen residents participated. The checklist scores ranged from 64-80% and improved from scenario 1 to 4. Overall Global rating scale scores were marginal and not significantly different between scenarios. The intraclass correlation coefficient of 0.69 (95% CI: 0.58, 0.78) represents a good interrater reliability for the checklist. Multiple critical errors were identified, the most common being not calling for help or a difficult airway cart. Conclusions Aside from identifying common critical errors, the authors noted that the residents' performance was poorest in two of our scenarios: "fetal distress and cannot intubate, cannot ventilate" and "maternal distress and cannot intubate, but can ventilate." More teaching emphasis may be warranted to avoid commonly identified critical errors and to improve overall management. Our study also suggests a potential for experiential learning with successive simulations.

The Impact of Paternal Depression in Infancy: A Mechanism for the Intergenerational Transmission of Risk

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1 ◽  
Author(s):  
V. Sethna ◽  
L. Murray ◽  
L. Psychogiou ◽  
P. Ramchandani
Keyword(s):  
Depressive Symptoms ◽  
Intergenerational Transmission ◽  
Rating Scale ◽  
Parental Psychopathology ◽  
Free Play ◽  
Global Rating Scale ◽  
Global Rating ◽  
Increased Risk ◽  
Paternal Depressive Symptoms ◽  
The Impact

The adverse influence of parental psychopathology on child development has been the focus of intense research in recent years, yet we are only beginning to understand the factors that explain this intergenerational transmission. Depressive symptoms in fathers have received relatively little attention when compared to research on the impact of maternal depression on children's emotional and behavioural problems. Recent evidence suggests that paternal depressive symptoms in the postnatal period are associated with an increased risk of toddler behaviour problems, which persist in clinical significance into childhood. This research examines a model of ‘social-environmental transmission’ of paternal psychopathology. We compared patterns of parent-infant interactions among families with depressed and non-depressed fathers to address the following question: Are the early interactions of depressed fathers characterised by maladaptive affect, behaviour and cognitions? This study is part of an on-going longitudinal investigation, The Oxford Fathers Project (OFP) of families who are followed when infants are 3 months to 2 years of age. Paternal behaviours, including verbal comments and interactive behaviour were examined during free-play with their 3-month old infants. Father's behaviour was coded from Fiori-Cowley and Murray's (1996) Global Rating Scale and verbal transcripts were examined for cognitive and mentalizing statements.Preliminary results suggest a higher proportion of infant directed negativity, in the verbal content of depressed fathers. Further analysis will be conducted and presented at the meeting. Discussion emphasises the importance of dysfunctional communication patterns in father-infant interactions that provide important clinical hypotheses as well as targets for identification and early intervention.

scholarly journals Impact of the Joint Advisory Group on Gastrointestinal Endoscopy (JAG) on endoscopy services in the UK and beyond

2018 ◽  
Vol 10 (2) ◽  
pp. 93-106 ◽  
Author(s):  
Keith Siau ◽  
John T Green ◽  
Neil D Hawkes ◽  
Raphael Broughton ◽  
Mark Feeney ◽  
...  
Keyword(s):  
Quality Assurance ◽  
Gastrointestinal Endoscopy ◽  
Rating Scale ◽  
Population Based ◽  
Global Rating Scale ◽  
Advisory Group ◽  
Global Rating ◽  
Endoscopy Training ◽  
The Uk ◽  
The Impact

The Joint Advisory Group on Gastrointestinal Endoscopy (JAG) was initially established in 1994 to standardise endoscopy training across specialties. Over the last two decades, the position of JAG has evolved to meet its current role of quality assuring all aspects of endoscopy in the UK to provide the highest quality, patient-centred care. Drivers such as changes to healthcare agenda, national audits, advances in research and technology and the advent of population-based cancer screening have underpinned this shift in priority. Over this period, JAG has spearheaded various quality assurance initiatives with support from national stakeholders. These have led to the achievement of notable milestones in endoscopy quality assurance, particularly in the three major areas of: (1) endoscopy training, (2) accreditation of endoscopy services (including the Global Rating Scale), and (3) accreditation of screening endoscopists. These developments have changed the landscape of UK practice, serving as a model to promote excellence in endoscopy. This review provides a summary of JAG initiatives and assesses the impact of JAG on training and endoscopy services within the UK and beyond.

scholarly journals The impact of respiratory protective equipment on difficult airway management: a randomised, crossover, simulation study

Anaesthesia ◽  
2020 ◽  
Vol 75 (10) ◽  
pp. 1301-1306 ◽  
Author(s):  
J. Schumacher ◽  
J. Arlidge ◽  
D. Dudley ◽  
M. Sicinski ◽  
I. Ahmad
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Simulation Study ◽  
Protective Equipment ◽  
Difficult Airway Management ◽  
The Impact

scholarly journals Reformulations of practice: beyond experience in paramedic airway management

CJEM ◽  
2016 ◽  
Vol 19 (04) ◽  
pp. 293-304
Author(s):  
Justin Mausz ◽  
Seanan Donovan ◽  
Meghan McConnell ◽  
Corey Lapalme ◽  
Andrea Webb ◽  
...  
Keyword(s):  
Airway Management ◽  
Situation Awareness ◽  
Rating Scale ◽  
Clinical Performance ◽  
Descriptive Analysis ◽  
Deliberate Practice ◽  
Global Rating Scale ◽  
Algorithmic Problem ◽  
Global Rating ◽  
Decision Paths

Abstract Objective “Deliberate practice” and “feedback” are necessary for the development of expertise. We explored clinical performance in settings where these features are inconsistent or limited, hypothesizing that even in algorithmic domains of practice, clinical performance reformulates in ways that may threaten patient safety, and that experience fails to predict performance. Methods Paramedics participated in two recorded simulation sessions involving airway management, which were analyzed three ways: first, we identified variations in “decision paths” by coding the actions of the participants according to an airway management algorithm. Second, we identified cognitive schemas driving behavior using qualitative descriptive analysis. Third, clinical performances were evaluated using a global rating scale, checklist, and time to achieve ventilation; the relationship between experience and these metrics was assessed using Pearson’s correlation. Results Thirty participants completed a total of 59 simulations. Mean experience was 7.2 (SD=5.8) years. We observed highly variable practice patterns and identified idiosyncratic decision paths and schemas governing practice. We revealed problematic performance deficiencies related to situation awareness, decision making, and procedural skills. There was no association between experience and clinical performance (Scenario 1: r=0.13, p=0.47; Scenario 2: r=−0.10, p=0.58), or the number of errors (Scenario 1: r=.10, p=0.57; Scenario 2: r=0.25, p=0.17) or the time to achieve ventilation (Scenario 1: r=0.53, p=0.78; Scenario 2: r=0.27, p=0.15). Conclusion Clinical performance was highly variable when approaching an algorithmic problem, and procedural and cognitive errors were not attenuated by provider experience. These findings suggest reformulations of practice emerge in settings where feedback and deliberate practice are limited.

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