DEVELOPMENT AND APPLICATION OF DIFFICULT AIRWAY ASSESSMENT SYSTEM TO IMPROVE MEDICAL QUALITY AND PATIENT SAFETY

Introduction: To maintain the airway patency is very important especially in the cardiac arrest patients.If unsuccessful endotracheal intubation occurs, the patient may cause to be hypoxic ischemic encephalopathy or death. Early detection of patients with difficult airway can decrease the risk of endotracheal intubation and increase the patient survival rate. The aim of this project is to build the difficult airway assessment system for patients in hospital and to improve the medical quality and patient safety. Methods: From August 2020 to December 2022, the team of multiple professions included emergency department, anaesthesia department, chest medicine doctors, nurses, information technology and quality management department. We used the methods such as brainstorming, documentation review, continuous education and information technological system. Phase one: we set up 8 consistent assessment items for patients in hospital and encourage the medical staff to finish every patient's evaluation. Phase two: there were continuous educations for resident doctors, PGY doctors and professional nurses. Phase three:A comprehensive analysis had carried out through the case analysis of the supporting intubation by anesthesia department and comparing the data of prior difficult airway assessment to understand the actual implementation situation from December 2021 to September 2022. Results: 1. Cross-team taskforce will be formed on August 2020, which composed of emergency department, anesthesia department, respiratory and chest department, nursing department, specialist department, information department, medical quality department and other departments required. 2. According to the relevant specialties, provide consistent evaluation standards that meet the requirements of the whole hospital, with a total of 8 items. After building the difficult airway evaluation system through information, it is set that each inpatient should be evaluated at least once, and the definition only needs to meet 1 of items which fit for difficult intubation. The system records the case of difficult airway, and the doctor activates the support mechanism according to the current emergence situation then to calls the intubation hotline. 3. Develop a difficult airway assessment process for outpatients, emergency and inpatients, and formulate regular standard operating procedures, which already be launched officially on April 2021. 4. Conduct physical education training courses gradually and continuous E-learning courses, which are stipulated as video courses for all Residents, PGYs and Specialist nurses, and they need to pass the test. 5. A comprehensive analysis had carried out through the case analysis of the supporting intubation by anesthesia department and comparing the data of prior difficult airway assessment to understand the actual implementation situation from December 2021 to September 2022.