Niagara Health


Type of Practice


Niagara Health (NH), is a multi-site hospital organization, has developed a multimodal, comprehensive strategy to manage patients with a Difficult Airway (DA) in a non-operative setting. In 2015, the organization experienced a number of poor outcomes (death) resulting from failed airways, which also had unintended secondary impacts, including physicians ending their careers in Emergency Medicine due to psychological trauma.
Airway events are twice as likely to occur outside the operating room with anoxic brain injury or death occurring. Algorithms to manage airways are often geared towards anesthetists or operating room environments. What was collectively understood in reviewing the events at Niagara Health was the need to provide support to those managing difficult airways with standardized methods of management, standardized equipment (as physicians provide coverage across all sites), standardized training and simulation.
NH implemented the Difficult Airway Pathway (DAP), an evidence-based strategy aimed to train staff to reduce critical events. The DAP initiative aligns with the LEADS framework for change management and includes an annual review of reported critical incidents and an Enterprise Risk Management (ERM) Assessment Summary, with the goal to “create a regional systematic approach to support personnel, equipment and education.” The guiding vision is: “Right people, Right equipment, Right timing: No failed airway.”
Since its inception there has been no critical incident (serious injury or death) or any reported airway incident in three years. It is projected that this initiative impacted 220 lives annually positively, and has resulted in physicians and other ED personnel from leaving the profession. 

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