HSSIB Reports

This recent report concerns advanced airway management of a patient with a known complex disease. Please do take the time to read this.

The recommendations require key stakeholders to act collaboratively to produce a framework for managing patients with an anticipated difficult airway. The RCoA and the Association of Anaesthetists are collaborating with DAS to do this.

At a local level home messages include:

• Please make sure your department is signed up to the DAS difficult airway database¹ if you haven’t already.
• Use this report as well as RCoA’s GPAS chapter for head and neck surgery² to push for access to video laryngoscopy, high flow nasal oxygen therapy and e-FONA equipment as well as other kit needed for advanced airway management. Another safety observation suggests that video laryngoscopy should be used more widely to increase experience.
• Use this report as evidence for the need to have time to train in advanced airway skills e.g. e-FONA for all anaesthetists, ODPs. This should be both task-based and critical incident training. The discussion on whether this should be mandated has re-surfaced, but individuals and organisations can begin this work without a mandate.
• When dealing with a case of this type, ensure that there are open communication lines with ENT colleagues so that they are aware of the patient, and are available to assist if required.

1. Difficult Airway Society. DAS Airway Alert Card and Difficult Airway Database.
2. Royal College of Anaesthetists. Guidelines for the Provision of Anaesthesia Services, Chapter 12: Guidelines for the Provision of Anaesthesia Services for ENT, Oral Maxillofacial and Dental surgery 2024 

This report recommends that hospitals consider the following questions, contained in the report to interrogate how effectively they involve temporary staff in patient safety investigations:

• How do you ensure that temporary staff are aware of how to report patient safety incidents?
• If an incident takes place, how do you ensure that temporary staff are able to record it?
• How do you engage temporary staff in a learning response?
• Do you have processes in place so you can conduct interviews with temporary staff?
• Can you work with employment agencies to create agreed methods of including temporary staff in learning responses through your contractual arrangements?
• How do you ensure that learning is fed back to those staff involved, including temporary staff?