DAS Project Grant
Modelling airway management using system reliability assessment tools
Dr Iain Moppett
Background
A fundamental part of safe anaesthesia and emergency care is ensuring a safe passage for breathing (the airway) and this is a key component of anaesthetic training. We know from clinical experience and research studies that this process is prone to minor glitches which impact on efficiency. Major failings are much less common, but potentially catastrophic and may lead to death or serious disability.
Engineers have had tools and techniques for a while which allow them to analyse complex processes and investigate when and how likely they are to fail. Until now these have not been widely used in clinical medicine. This is partly because every patient is unique so researchers have been reluctant to apply methods from the more predictable world of production and manufacturing. The methods that engineers use have become more sophisticated in recent years, and we believe they may be of value in analyzing clinical behaviour. We therefore wish to use these tools to try to understand better when and why airway management fails.
Methods
To do this we need to collect information about what the sequence of events is, and in particular what it is that makes anaesthetists decide on one course of action or another. We will do this in two ways. In one part of the project we will make video and audio recordings of routine anaesthesia and airway management, following discussion and written consent from all those taking part, including the patients.
These recordings will then be reviewed by the anaesthetist and experts in human decision making and engineering reliability to identify what actions are taken, how long they take, why they were taken and what might happen if they don't work. In parallel to this we will be running two workshops where volunteer anaesthetists and theatre staff discuss with the researchers airway management issues from situations that were more complex or did not go according to plan. The information should give a very rich description of both what happens, but also why certain choices are made.
This information will then be used to create an engineering model (computer program) which will recreate airway management in the computer laboratory. This model will be tested to make sure it behaves in accordance with what we expect. It will then be used to examine how airway management is affected by the decision making process and constraints, such as staff, equipment and drugs availability.
Future work
We anticipate that this work will provide us with a tool which can be used to improve airway management. This would come through highlighting areas which can be optimized in the routine situation. We hope to be able to use the tool to look at how emergency drills (such as those used in aviation) actually work (or don't work) given the variability in patients, time pressures and skills of the staff. If successful, the work will have a wider applicability to other areas of clinical practice including surgery and safe transfer of patients within hospitals.
