Modelling Airway Management using System Reliability Assessment Tools

Airway management can be considered as a complex engineering process which includes a series of sequential or simultaneous actions (e.g., tasks or decisions) using different resources i.e., time, people, equipment and medications. We explored the decision-making and actions during the process of routine airway management. To elicit an understanding of cognitive strategies applied and influences on strategy selection using the Critical Decision Method. The task steps involved in action and decision making during the induction of routine airway process in both routine and complicated cases were identified using hierarchical task analysis. The systematic human error reduction and prediction approach was then used to examine the task steps at the lowest level of hierarchical task analysis in more detail. There were differences in airway practice and preparation between participants. The decisions were primarily made by the lead consultant anaesthetist, with the trainees and Operating Department Practitioners (anaesthetic nurse) supporting these decisions. Much of the team communication used code language, which appeared to be well understood by the team members and did not obviously impede performance in the context of routine airway management. Most of the experienced lead consultant anaesthetists rely on their past experience of "work-as-done" during the airway process. The results from this study illustrated that human factors and non-technical skills are important for airway management and for ensuring safe, high-quality intraoperative care. Further research is needed to determine how these skills work in conjunction and how they impact anaesthetic performance.