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Anesthesia Patient Safety: Perioperative Airway Management Survey

Please use the Manage Form Option to Develop your Form

Please tell us about yourself
1. Please identify your professional training*
Anesthesiologist
Resident in anesthesia
CRNA
Student nurse anesthetist (SRNA)

2. Please identify the practice you are in*
Private practice
Private practice affiliated with a teaching program
Academic practice
Solo/ small group (< 5) practice

3. Please tell us about your practice
a. Name of hospital:*

b. Location:*

Perioperative Airway Management Survey Questions
1. When was the most recent time you had an unanticipated difficult airway. (Defined as an unanticipated difficult laryngoscopy needing extra help and/or accessory rescue airway devices; e.g. LMA’s for airway management.)*
Last 7 days
Last 30 days
Last 6 months
Last 12 months or earlier

2. How many planned Fiberoptic intubations (awake or asleep) do you do in a one month period. (Approx)*
0
1 to 5
5 to 10
> 10

3. Once your patient has been established as having a difficult airway, what is the current practice of your group as a follow up for this patient?*
Do not know
A letter detailing the problem is given to the patient
Order a medical alert product for the patient
Update and flag this patient in your institution’s airway database

4. How does your practice identify a patient with a known difficult airway who returns for an anesthetic at a later date?*
The patient brings the “difficult airway letter” or medical alert product
The patient tells you during the pre operative evaluation
Based on the review of the previous anesthetic record
The patient was automatically “flagged” upon admission based upon your difficult airway database

5. Does your practice have*
An electronic database of patients with known difficult airways
A paper format database of patients with difficult airways
Do not maintain a database
Do not know

6. How do NON-ANESTHESIA providers who handle airways (ER, Critical Care, etc) in your hospital know if your patient has a difficult airway?*
Do not know
Have to rely on anesthesia perioperative documentation on the chart
Call anesthesia for all airway issues
Other-please explain

---Enter explanation to question 6 above here if needed

7. As someone with significant airway management experience, do you think that a difficult airway can pose a life threatening risk if managed incorrectly or by less experienced personnel?*
Yes
No
Maybe
Other-please explain

---Enter explanation to question 7 above here if needed

Submit

* Required

Thank you for your time.

Avinash B Kumar MD, FCCP

Assistant Professor Anesthesiology and Critical Care

University of Iowa Hospitals and Clinics

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