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NSW Emergency Department Airway Registry Project

Royal North Shore Hospital
Project Added:
15 October 2014
Last updated:
29 October 2014

Summary

A prospective observational study of the practice of endotracheal intubation in NSW Emergency Departments (EDs) with subsequent development of practice improvement guidelines and training. 

Aim

To collect data on the practice of endotracheal intubation in the ED. This procedure carries a higher risk of complications when performed in the ED compared with operating theatres yet little is known about the specifics of this across the range of EDs in NSW.

Benefits

  1. This project will provide each participating department the data that they will require for audit of their practice, with the hope that departments will highlight areas of potential process improvement and then enact change. 
  2. Pooled data will be used for a descriptive study of the practice of intubation in Australasian EDs, with particular emphasis on the indication, staff seniority, techniques (e.g. induction drugs or type of laryngoscope), number of attempts at laryngoscopy required and the rate of complications. We will compare tertiary, urban district and regional EDs, as well as FACEM/Registrar/CMOs (or equivalent), with regard to the above metrics.
  3. Publish the findings of the above research in a peer reviewed journal.
  4. Develop guidelines and recommendations for intubation in EDs based on the results.
  5. Develop a training package for doctors working in EDs.

Project status

Implementation: The initiative is ready for implementation, is currently being implemented, piloted or tested.

Project started:  January 2013

Background

Advanced airway management is an accepted core skill of Emergency Physicians in Australasia. Rapid sequence intubation (RSI) is, however, a high-risk procedure that has been shown to have an increased rate of severe complications – such as failed intubation, hypoxia, hypotension or surgical airway – when it takes place in the ED in comparison to the operating theatre. 

The recently published Fourth National Audit of Major Complications of Airway Management in the UK reviewed severe complications associated with airway management in the ED

The authors found that a large proportion of events occurred out of hours, without consultant supervision, or without the operators following standard airway management algorithms and “failing to plan for failure.”

Several studies have been published that describe the performance of intubation in the EDs of North America, UK, Korea and Japan, but to date, only a single centre study has been published from an Australian ED

This study, carried out at the Royal North Shore Hospital, prompted significant changes in the practice of intubation in that ED, along with an increased educational focus on the subject, in order to improve clinical management.

Implementation sites

The study resides within NSW with Royal North Shore Hospital as the lead site. The Emergency Care Institute (ECI) is providing support and partnership for the project, and developing partnerships throughout Australia and New Zealand.  

NSW sites contributing to airway registry

  • Hornsby Ku-ring-gai Hospital 
  • Manly Hospital 
  • Mona Vale Hospital
  • Prince of Wales Hospital 
  • Royal North Shore Hospital
  • Royal Prince Alfred Hospital
  • St George Hospital
  • St Vincents Hospital
  • Wagga Wagga Base Hospital 
  • Westmead Hospital
  • Wollongong Hospital

NSW sites awaiting ethics approval

  • Blacktown Hospital
  • Bowral and District Hospital 
  • Calvary Mater Hospital
  • The Children's Hospital at Westmead 
  • Dubbo Hospital
  • John Hunter Hospital 
  • Lismore Hospital 
  • Liverpool Hospital 
  • Mt Druitt Hospital
  • Nepean Hospital
  • Orange Hospital
  • Port Macquarie Hospital
  • Queanbeyan Hospital
  • Tamworth Hospital 
  • The Tweed Hospital 

Partnerships

  • Cairns Base Hospital (QLD)
  • Gove District Hospital (NT)
  • Middlemore Hospital (NZ)
  • Queensland Emergency Medicine Research Foundation
  • Royal Hobart Hospital (TAS)
  • Sir Charles Gairdner Hospital (WA)
  • Sunshine Hospital (VIC)
  • Townsville Hospital (QLD)
  • Western Hospital (VIC)

Contact

Dr Toby Fogg
ED Specialist, Royal North Shore Hospital
Northern Sydney Local Health District
Email: tobyfogg@mac.com

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