RESPIRATION AND THE AIRWAY Anticipation of the difficult airway: preoperative airway assessment, an educational and quality improvement tool

Editor’s key points † This study addresses the impact of a comprehensive airway assessment form, including all 11 ASA’s airway risk factors, on resident education, while assessing is of questionable value. † Completion of this specially designed airway assessment form led to significantly better documentation; however, it did not appear to have a clinically significant impact. Background. Assessment of the potentially difficult airway (DA) is a critical aspect of resident education. We investigated the impact of a new assessment form on airway prediction and management by anaesthesia residents. We hypothesized that residents would demonstrate improvement in evaluation of DAs over the study duration. Methods. After IRB approval, anaesthesia residents were randomized into two groups: control (existing form) and experimental (new form). Data were collected prospectively from August 2008 to May 2010 on all non-obstetric adult patients undergoing non-emergent surgery. Results. Eight thousand three hundred and sixty-four independent preoperative assessments were collected and 8075 were analysed. The experimental group had the higher completion rate than the control group (94.3 % vs 84.3%, P0.001). DA prediction was higher for the control group (71.2%) compared with the experimental group (69.1%; P0.032). A significant improvement in prediction rates was found over time for the experimental group (likelihood estimate0.00068, P0.031). Conclusions. The use of a comprehensive airway assessment did not improve resident ability to predict a DA in an academic, tertiary-based hospital, anaesthesiology residency training programme