Improving Handoffs for Tracheotomy Patients: Introducing the Connecticut Airway Risk Evaluation to Otolaryngologists

Abstract

Objectives:

(1) Describe the Connecticut Airway Risk Evaluation (CARE) system, an airway grading system describing the risk of a patient’s airway above the tracheotomy tube. The CARE was designed to improve handoffs between caregivers for tracheotomized patients. (2) Analyze the reliability of teaching and ease of learning the CARE system for otolaryngologists.

Methods:

The CARE system is a simple, easy to use scale that divides patients into the following groups: 1, easily intubatable; 2, intubatable with specialized techniques or equipment; or 3, not intubatable. A brief tutorial was designed to introduce the system and was presented to a group of otolaryngologists. A 30-point questionnaire was administered in which patients’ airways and airway management techniques were described, and the participant was asked to grade each example according to the CARE system.

Results:

Fifteen participants completed the study, including 9 attending physicians and 6 resident physicians. Overall interrater reliability was calculated for all participants with a 90.3% agreement (Kappa = 0.837). Attending physicians had a 86.1% agreement (Kappa = 0.766). Resident physicians showed 98.9% agreement (Kappa = 0.981).

Conclusions:

The CARE system is a reliable method of classifying airway risks in the event of an airway emergency in a tracheotomized patient. We have shown that the CARE system can be easily taught to otolaryngologists with high interrater reliability. The CARE system may help simplify handoffs between caregivers while emphasizing the important aspects of a patient’s airway. Adequate implementation of the CARE system may improve the understanding of airway management options in complex tracheotomized patients.