Optimising difficult airway documentation: implementation of an automated update in the electronic health record

Editor—Difficulty encountered during airway management results in significant morbidity and mortality. 1 Joffe A.M. Aziz M.F. Posner K.L. Duggan L.V. Mincer S.L. Domino K.B. Management of difficult tracheal intubation: a closed claims analysis. Anesthesiology. 2019; 131: 818-829 Crossref PubMed Scopus (118) Google Scholar ,2 Frerk C. Mitchell V.S. McNarry A.F. et al. Difficult Airway Society intubation guidelines working group: difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth. 2015; 115: 827-848 Abstract Full Text Full Text PDF PubMed Scopus (1223) Google Scholar Prior procedural difficulty or failure is the most sensitive predictor for challenging airway management. 3 Apfelbaum J.L. Hagberg C.A. Connis R.T. et al. 2022 American Society of Anesthesiologists practice guidelines for management of the difficult airway. Anesthesiology. 2022; 136: 31-81 Crossref PubMed Scopus (192) Google Scholar Existing guidelines suggest performing airway risk assessment before initiating management, including review of prior airway history. 3 Apfelbaum J.L. Hagberg C.A. Connis R.T. et al. 2022 American Society of Anesthesiologists practice guidelines for management of the difficult airway. Anesthesiology. 2022; 136: 31-81 Crossref PubMed Scopus (192) Google Scholar ,4 Law J.A. Broemling N. Cooper R.M. et al. The difficult airway with recommendations for management—part 1—difficult tracheal intubation encountered in an unconscious/induced patient. Can J Anaesth. 2013; 60: 1089-1118 Crossref PubMed Scopus (247) Google Scholar Structured notes within the electronic health record have helped providers improve difficult airway management documentation, which might reduce adverse events. 5 Schechtman S.A. Flori H.R. Thatcher A.L. et al. The difficult airway navigator: development and implementation of a health care system’s approach to difficult airway documentation utilizing the electronic health record. A A Pract. 2021; 15e01455 PubMed Google Scholar , 6 Matava C. Caldeira-Kulbakas M. Chisholm J. Improved difficult airway documentation using structured notes in Anesthesia Information Management Systems. Can J Anaesth. 2020; 67: 625-627 Crossref PubMed Scopus (4) Google Scholar , 7 McGrath B.A. Calder N. Laha S. et al. Reduction in harm from tracheostomy-related patient safety incidents following introduction of the National Tracheostomy Safety Project: our experience from two hundred and eighty-seven incidents. Clin Otolaryngol. 2013; 38: 541-545 Crossref PubMed Scopus (30) Google Scholar , 8 Rameau A. Wang E. Saraswathula A. Pageler N. Perales S. Sidell D.R. Enhancing pediatric airway safety using the electronic medical record. Laryngoscope. 2018; 128: 2885-2892 Crossref PubMed Scopus (3) Google Scholar Accurate documentation of difficult airway management is not universally practised, as a recent investigation revealed that only 31% of patients with a defined difficult airway had appropriate documentation in their health records. 9 Cloyd B.H. Leis A.M. Healy D.W. Schechtman S.A. Teig M. A retrospective observational study of airway management features resulting in difficult airway letters at a single center. J Clin Anesth. 2022; 83110984 Crossref PubMed Scopus (1) Google Scholar