Compliance with an anaesthesia pre-induction checklist aiming to improve patients’ safety during airway management: a retrospective five-year analysis

Fuchs, Alexander; Frick, Sarah; Berger-Estilita, Joana; Greif, Robert (28 October 2021). Compliance with an anaesthesia pre-induction checklist aiming to improve patients’ safety during airway management: a retrospective five-year analysis. Swiss medical weekly, 151, 10S-10S. EMH Media

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Background: Airway management is still considered as a high-risk pro-cedure and about 10% lead to fatal patients’ consequences with lifelongimpairment or death (NAP4). Despite clinicians’ technical skills and ex-pertise, human factors (e.g. situational awareness, communication) con-tribute to successful airway management. Human factors can be in-fluenced by cognitive aids like checklists (structural approach for usersto prevent human errors). In 2016, a local pre-induction checklist beforestart of general anaesthesia was implemented containing four items:equipment, patient, communication and feasibility. This retrospective observational study measures the compliance to the checklist over 5 years. Methods: Study period: 01 May 2016 until 31 May 2021Inclusion criteria: all procedures with airway management ( general anae-sthesia) Exclusion criteria: procedures without airway managementPrimary endpoint: percentage of completed pre-induction checklists Secondary endpoints: standard working hours (7:00h – 16:59h) vs. on-call hours (17:00h – 6:59h), area of induction, urgency of the procedureand difficult airwayResults: Of the total 122,456 included procedures, 48.4% had a com-plete pre-induction checklist and compliance improved significant from39.3% in 2017 to 53.7% in 2020 (p < 0.001).During the study period, pre-induction checklist was complete:In 50.4% during standard working hours vs. 34.4% in on-call hours (p <0.001)In 52.5% in the operating rooms vs. 35.2% in non-operating rooms (p <0.001)In 53.1% of elective procedures vs. 33.3% in emergency procedures (p <0.001)Difficult airway was encountered in 3.6% (n = 4,404) of all procedures:4.1% during on-call hours vs. 3.5% standard working hours (p > 0.001)4.2% in non-operating-rooms vs. 3.4% in operating rooms (p < 0.001)4.1% in emergency procedures vs. 3.4% in elective procedures (p <0.001)Conclusion: This retrospective analysis showed an increase of the u-sage of the pre-induction checklist over the five years up to 54%. Com-pliance was higher for procedures during standard working hours, in theoperating rooms and for non-emergency procedures. Procedures with a difficult airway occurred more frequently during on-call hours, in non-operating-room anaesthesia, and during emergency procedures. Assuch pre-induction checklists aim to reduce potential human errors, wewill investigate barriers and facilitators for the checklist use to close thelarge gap in cases without application of this safety tool.

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