Human factors in the development of complications of airway management: preliminary evaluation of an interview tool

Abstract

Summary The 4th National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society (NAP4) analysed reports of serious events arising from airway management during anaesthesia, intensive care and the emergency department. We conducted supplementary telephone interviews with 12 anaesthetists who had reported to NAP4, aiming to identify causal factors using a method based on the Human Factors Investigation Tool (HFIT). We identified contributing human factors in all cases (median [range] 4.5 [1–10] per case). The most frequent related to: situation awareness (failures to anticipate, wrong decision) (nine cases); job factors (e.g. task difficulty; staffing, time pressure) (eight cases); and person factors (e.g. tiredness, hunger, stress) (six cases). Protective factors, such as teamwork and communication, were also revealed. The post‐report HFIT interview method identified relevant human factors and this approach merits further testing as part of the investigation of anaesthetic incidents.

The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: patient experiences, human factors, sedation, consent and medicolegal issues

“…The methodology of the NAPs does not lend itself to full analysis of human factors and so is likely to underestimate its role [44]. However, the detailed information captured provides the opportunity to explore causal events, action errors and latent/contributory factors.…”

Role Allocation and Team Dynamics during Pre-Hospital Rapid Sequence Induction of Anaesthesia by a Physician-Critical Care Paramedic Team in the United Kingdom: A 12 Months Review of Practice

“…It is however possible that extraneous factors at scene such as the number and acuity of patients meant that the allocation of a land paramedic in this role provided the safest and most expedient approach to securing a definitive airway. Managing cognitive burden through recognising and mitigating the risk of overload are important skills for pre-hospital personnel [3,4,9,10]. Adaptability and fluidity of roles in the context of pre-hospital RSI have great advantages to manage the demands of delivering the intervention in extremely challenging environments but are also associated with potential pitfalls.…”

“…In addition to the demands of ensuring safe and efficient endotracheal intubation, teams delivering pre-hospital RSI have to contend with a myriad of other potential challenges at incident scenes. Clear and effective team dynamics, underpinned by robust governance and training structures, are essential components of the skill armamentarium of personnel involved in the delivery of such skills in the Pre-hospital environment [2][3][4]. Standard Operating Procedures (SOPs) for pre-hospital RSI in the United Kingdom (UK) lack uniformity [5].…”

Military experience of human factors in airway complications

“…We were pleased to read the article by Flin and colleagues [1] based around the landmark NAP4 work [2] and applaud the review of human factors in airway complications. Within Defence Anaesthesia we have been very aware of the importance of human factors when dealing with time-critical complex trauma [3].…”

“…It is stated that liquids boil at certain temperatures -boiling points -when their saturated vapour pressure (SVP) equals atmospheric pressure [1]. The link between SVP and atmospheric pressure is not self-explanatory because the vapour pressure at the surface is not SVP; by definition, a boiling liquid is not in equilibrium with its vapour, because if left boiling, it will evaporate fully.…”