Documentation and communication of the ‘difficult airway’


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In 2003, Barron et al. published their work on how UK anaesthetists organise, document and communicate difficult airway management [1]. They introduced an ‘Airway Alert’ form to help to communicate specific information about the ‘difficult airway’ to subsequent anaesthetists. This form has been adopted by the Difficult Airway Society (DAS) and is available to download from their website ( We were interested to ascertain the level of awareness of this form and whether procedures have changed in the way that anaesthetists document and communicate about patients with difficult airways since Barron's suggestions. We sent an anonymous questionnaire to anaesthetists in two local district general hospitals asking what action they take when they encountered a difficult airway. We received 69 replies from 104 questionnaires (a response rate of 66%).

Table 3 summarises the results obtained and compares them with those of Barron et al. It would appear that we are all very good at talking to patients and making a note of our difficulties on their anaesthetic chart but we fall short of carrying out the further measures suggested by Barron et al. The questionnaire also asked about the use and awareness of the ‘Airway Alert’ form. Fewer than one in five of respondents were aware of it, with only 2% having ever used it. A telephone survey of senior trainees representing seven other hospitals in the region confirmed a low level of awareness (10%). Given the results in our region we can make the assumption that the situation is similarly disappointing in many other hospitals. However, we take encouragement from the fact that once introduced to the idea of the ‘Airway Alert’ form, 88% of respondents said they would be keen to use it were it made readily available in their hospital.

Table 3.   Documentation and communication of the difficult airway in a two district general hospitals (2006 survey) compared with the results of Barron et al.[1]. Values are percentage answering ‘yes’.
 2006 surveyBarron et al.
Patient informed 94 98
Written information given to patient 19 40
Note made on patient's anaesthetic chart100100
Entry made in patient's case record 62 71
Warning put on patient's notes 35 77
Patient's General Practitioner informed 16 27
Patient referred to MedicAlert 14 11

We suggest that further attention needs to be drawn to this issue and hope that the publication of this letter will again highlight the work of Barron et al. and their ‘Airway Alert’ form. We propose that copies of the form be kept on the difficult airway trolley in every anaesthetic department and that trainees be inducted in the concept on their arrival to a new hospital.