ASPO049 - Implementation Of A Pediatric Difficult Airway Registry And Inpatient Management Process
Saturday, April 30, 2022
4:00 PM – 5:00 PM CT
Location: Landmark B
Robert A. Weatherly, M.D.1, Rachel A. Quaile, APRN1, Karen Beaudet, APRN1, Samantha Cornell, APRN1, Neal Campbell, M.D.2, Summer Smith, APRN2, Emily Keeven, RRT3, Lisa Carney, M.D.4, Paul Bauer, M.D.4;
1Surgery/Otolaryngology, Children's Mercy Kansas City, Kansas City, MO, 2Anesthesiology, Children's Mercy Kansas City, Kansas City, MO, 3Respiratory Therapy, Children's Mercy Kansas City, Kansas City, MO, 4Pediatrics, Children's Mercy Kansas City, Kansas City, MO.
Nurse Practitioner Children's Mercy Hospital - Otolaryngology Kansas City, Missouri
Introduction: Advanced recognition and management of the difficult pediatric airway may prevent negative airway outcomes. Following the identification of gaps at our institution which potentially placed difficult airway patients at risk, a difficult airway registry and inpatient management process were implemented with a goal of preventing adverse airway events.
Methods: A proposal was utilized to guide our efforts based on LEAN principals (“A3”). A multidisciplinary work group was formed, and an example of a difficult airway registry from another pediatric institution was reviewed - then adapted for use at our institution. Standard “difficult airway” terminology and definitions were determined. Processes for patient identification, registry inclusion, emergency notification of airway experts and inpatient surveillance were developed. Additional methods including documentation, EMR alerts, bedside signage, event review and registry maintenance were standardized.
Results: During our first year, a total of 105 patients were added to the registry. 89 of these patients remain active. 12 patients were removed following resolution. 4 patients died from non-airway causes. No adverse airway events occurred. One event report was entered during the first year, identifying a missing piece of bedside equipment.
Conclusion: The difficult airway registry and inpatient management process are proactive measures for the potential prevention of problematic airway outcomes. Oversight by airway experts in Anesthesiology and Otolaryngology ensures accurate categorization and overall value of the registry. Continued identification and management of this population is a multidisciplinary effort. The majority of identified difficult airway patients have history or physical exam findings supporting such categorization. We hope all such patients benefit from enhanced awareness of our pediatric difficult airway protocol and our standard processes for obtaining emergency airway assistance.