PP03 The use of ‘pop-up’ simulation sessions to improve the competency and confidence of anaesthetists in emergency front of neck access (E-fona)

Abstract

Aim NAP 4 highlighted a high failure rate for anaesthetists performing Emergency Front of Neck Access (E-FONA); 56% for theatre cases,1 despite this being an essential skill for Anaesthetists of all grades. As a result, the Difficult Airway Society (DAS) produced new guidelines in 20152 including surgical E-FONA, however, this remains a rarely used and often infrequently practiced technique. Evidence has shown that simulation-based medical education can improve patient safety and improve clinical skills,3 as a result we designed a low-fidelity, pop-up simulation session to improve clinical knowledge and competence in this essential area. Objectives To increase accessibility and engagement of anaesthetists with E-FONA simulation, To improve competence and confidence of anaesthetist with E-FONA techniques. Summary of work undertaken A portable ‘pop-up’ low fidelity simulation station was prepared to allow anaesthetists to practice Surgical and Cannula E-FONA techniques on a front of neck mannequin alongside DAS 2015 Guidelines. The ‘pop-up’ simulation was taken to anaesthetic rooms of functioning theatre lists to enable maximum interaction with anaesthetists. The simulation was manned by two competent anaesthetists; one to facilitate the simulation and the other to supervise the patient in theatre, allowing the list anaesthetist to fully engage in the session. Participants were able to review the DAS 2015 Guidelines before practicing both Surgical E-FONA and Needle Cricothyroidotomy. They were asked to indicate the time since they last read the DAS guidelines and since they practiced E-FONA techniques before rating their confidence with the procedure out of ten both before and after the pop-up session. Impact on practice 17 Anaesthetists participated in the simulation session. Participants had read the DAS 2015 guidelines with varying frequency, between 3 weeks and >1 year ago. 11 of the participants had not practiced E-FONA for >6 months. Average confidence scores were 4.8/10 pre-simulation and 7.6/10 post-simulation, with an average increase in confidence score of 2.8/10. This increase in confidence was analysed with a Paired Student’s T-Test producing a p Value of 0.0013 (significance defined as p References . Royal College of Anaesthetists, 4th National Audit Project; Major complications of airway management in the UK; NAP 4: Full report. March 2011. [Available at] www.rcoa.ac.uk . DAS guidelines for management of unanticipated difficult intubation in adults2015. Available at www.das.uk.com/guidelines/das_intubation_guidelines [Accessed 26/04/2018]. . Motola I, Devine L, Chung H. Simulation in healthcare educations: A best evidence practical guide. Medical Teacher (AMEE Guide No. 82) 2013;35:e1511–e1530.