# Awake Tracheal Intubation Training in a Newly Established Anaesthesia Department: An Audit of Over 200 Patients With Anticipated Difficult Airway

## TL;DR

This study shows how a new hospital improved awake tracheal intubation training and patient outcomes through a quality improvement project.

## Contribution

A novel quality improvement framework for training anaesthetists in awake tracheal intubation in a newly established hospital.

## Key findings

- A 100% success rate in awake tracheal intubation after implementing training and protocols.
- High patient satisfaction with pre-procedure counseling and airway management.
- 45% of patients recalled the event at 12 weeks, with 9% having a negative recall.

## Abstract

Background: Awake tracheal intubation (ATI) remains the gold standard in the management of a difficult airway. However, training in this technique is suboptimal. This has major implications for patient safety as well as anaesthetists’ skill set. The report presents a quality improvement project on ATI at a newly established tertiary care hospital in India.

Methods: This project included an initial audit to identify the gaps in knowledge and skill in ATI, implementation of identified measures, followed by a re-audit to evaluate competency in ATI and patient satisfaction with airway management. Patients were followed up over the telephone at 12 weeks post-procedure to assess recall of the event. The primary outcomes included patient satisfaction with the management of difficult airway and any adverse recall of events at three-month follow-up.

Results: The initial audit was performed in April 2024, which revealed a paucity of skill in ATI, the unavailability of flexible bronchoscopes for training, and a lack of a formal protocol. The re-audit was performed from May 2024 to April 2025. During this period, 203 ATIs were performed by 16 anaesthetists with a 100% success rate. Patient satisfaction with pre-procedure counselling and airway management was high. The complication rate was low. At the 12-week telephone review, 45% of patients recalled the event, and 9% of patients had a negative recall associated with the event.

Conclusion: Training in ATI should be integrated with routine airway management to enhance expertise and confidence in the technique as well as patient safety.