Skip to main content

Advertisement

Table 1 The definitions of the possible states of the risk influencing factors (RIF).

From: Risk assessment of pre-hospital trauma airway management by anaesthesiologists using the predictive Bayesian approach

RIF Possible states of RIFs
  Poor Average Good
Culture and Attitudes - Does not adhere to current recommendations or guidelines for advanced pre-hospital airway management.
- Ignores good practice
- Relies only on own opinion of what is best practice
- Thinks that own skills are sufficient and that there is no need for practice outside clinical practice
- Not aware of or neglects use of protocol
- Overly confident in own ability to handle complications
- Does not believe that serious complications will occur
- Performs procedure for the benefit of the procedure, not to improve patient condition
- Does not believe in protocols
- No formal training of new providers
- Performed by an unsupervised, inexperienced provider
- Does not recognise experience and practise of other related services
- Do not acquire new knowledge on a regular basis
- No culture for feedback from receiving hospital
- Between good and poor - Adheres to current recommendations and guidelines for advanced pre-hospital airway management, uses them in daily practice.
- Has back-up from experienced provider
- Positive attitude towards use of protocol to improve procedure safety
- Prioritises patient safety
- Formal training program for new providers
- Takes preventive measures to avoid complications
- Learns from own experience and complications
◦ Individual
◦ Department
- Open learning environment
- Novice operators under direct supervision from experienced operator
- Interacts with other services to improve quality
- Has "system" of acquiring feedback from receiving hospitals
Providers experience and knowledge - Not competent in advanced airway management
- Unfamiliar with difficult airway algorithm
- Has no strategy for checking the patency of the airway after the procedure
- Is not up to date on current recommendations and guidelines for advanced pre-hospital airway management
- No defined relevant role model for own activity
- Focus on own standing and career rather than patient outcome
- Random assistant during airway procedures
- Competent in advanced airway management
- Knows difficult airway algorithm
- Checks patency of the airway at regular intervals
- Has limited knowledge of current recommendations and guidelines for advanced pre-hospital airway management
- Has trained assistant (that is integrated in the crew) for airway procedures, but makes irregular use of assistance
- Competent in advanced airway management
- Competent in difficult airway management
- Familiar with local back-up airway equipment
- Familiar with potential airway complications in the pre-hospital setting and the handling of these
- Monitors the patency of the airway after the procedure
- Knows the current recommendations and guidelines for advanced pre-hospital airway management, especially the use of tracheal intubation.
- Uses trained assistant (that is integrated in the crew) during airway procedures
System - System has no policy on hiring providers experienced in pre-hospital medicine
- Most providers are inexperienced in pre-hospital medicine or are in-training
- There is no system for training or retraining the providers in advanced airway management
- No system for quality assurance
- No formal R&D activities
- Techniques and equipment used for advanced airway management is not up to date with current standards
- System hires mostly providers experienced in pre-hospital medicine or specialists within their field
- The providers are trained in some of the skills and procedures related to advanced airway management at regular interval or all procedures at irregular intervals
- System hires only providers experienced in pre-hospital medicine and specialists within their field
- All providers are trained and retrained regularly in all skills and procedures related to advanced airway management, including rescue techniques
- Techniques and equipment used in advanced airway management are up to date with current standards
- Service registers activity data from advanced airway management and uses data for quality improvement and research
Protocol compliance - No protocol available or available protocol is not followed
- Protocol do not match provider competence
- Protocol available, but does not give a clear framework for the procedure (see "good")
- Partially follows protocol
- Protocol for advanced pre-hospital airway management exists.
- Protocol defines framework for the procedure
- Protocol defines measures to improve quality and safety of procedure
- Protocol defines team roles
- Protocol is followed in all cases
- Protocol is regularly updated to comply with current knowledge