An Audit of Essential Difficult Airway Trolley Equipment in Selected Regional NSW Hospitals
Patrick Lay, Stuart Lawrie, and Anthony Gray
Introduction:
In 2021, the Australian and New Zealand College of Anaesthetists (ANZCA) updated its Guideline on Equipment to Manage Difficult Airways1 to address the withdrawal of multiple devices since the 2010 publication. The revision reflects the removal of outdated equipment, the introduction of new technologies, and evolving approaches to difficult airway management2. Implementing the recommendations is crucial, as managing a difficult airway depends on the timely availability of appropriate equipment3.
Objective:
The audit aimed to assess the availability of essential equipment on difficult airway trolleys (DAT) across four regional NSW hospitals to uphold ANZCA’s principles of standardisation, redundancy, and a culture of safety2. The audit findings will support departmental discussions and guide the review of DAT contents to establish a standardised trolley across all sites, which is especially important as specialist anaesthetists work across these hospitals.
Methods:
A checklist-based audit tool was created using the updated ANZCA guidelines1, and a pilot audit was conducted. This identified compliance discrepancies, initiating departmental discussions amongst specialist anaesthetists. The same tool was then used to assess compliance at three other regional hospitals.
Results:
While the four sites largely met the ANZCA guidelines, there were inconsistencies, particularly in tracheal tubes, syringes, facemasks, oropharyngeal airways, and some eFONA components. The layout of DATs varied, and the stocking of redundant devices and non-essential items was a common finding across all sites.
Conclusion:
The audit highlights discrepancies in equipment stocked on DATs across the four sites. This emphasises the importance of establishing a standardised DAT model that includes all ANZCA-recommended essential difficult airway equipment. Consulting with airway leads can help identify and remove redundant or non-essential items. To ensure ongoing compliance with ANZCA guidelines, regular audits should be performed.
References
- Australian and New Zealand College of Anaesthetists (ANZCA). (2021). PG56(A) Guideline on equipment to manage difficult airways 2021. https://www.anzca.edu.au/getattachment/02fe1a4c-14f0-4ad1-8337-c281d26bfa17/PG56(A)-Guideline-on-equipment-to-manage-difficult-airways-2021.
- Australian and New Zealand College of Anaesthetists (ANZCA). (2021). PG56(A)BP Guideline on equipment to manage difficult airways – Background Paper 2021. https://www.anzca.edu.au/getattachment/9ef4cd97-2f02-47fe-a63a-9f74fa7c68ac/PS56BP-Guideline-on-equipment-to-manage-difficult-airways-Background-Paper.
- Baker PA, Flanagan BT, Greenland KB, Morris R, Owen H, Riley RH, Runciman WB, Scott DA, Segal R, Smithies WJ, Merry AF, Australian and New Zealand College of Anaesthetists. Equipment to manage a difficult airway during anaesthesia. Anaesth Intensive Care [Internet] 2011 [cited 2025 March 29];39(1):16-34. Available from: https://pubmed.ncbi.nlm.nih.gov/21375086/ Doi: 10.1177/0310057X1103900104