Difficult Airway Alert

Initiative Type
Service Improvement
07 November 2018
Last updated
05 June 2020


"The term ‘Difficult Airway’ refers to the presence of any clinically significant threat to oxygenation and / or ventilation with difficulty in any of the key domains of airway management i.e. difficult or impossible bag-mask ventilation, supraglottic airway insertion, tracheal intubation or front of neck access."

The Difficult Airway Alert and glossary of terms are the culmination of several months of extensive research and wide spread consultation across the public and private health sectors by the Statewide Anaesthesia and Perioperative Care Clinical Network (SWAPNet) Difficult Airway Alert Working Group.

When a difficult airway situation arises, the form is completed by a senior clinician involved in the event and uploaded to The Viewer and/or ieMR by designated officers in Queensland Health facilities and a copy is provide to the patient and GP as required.

A submission has been lodged to have the Difficult Airway Alert considered for inclusion in the MyHealth Record.

The Difficult Airway Alert has been endorsed by the Australian and New Zealand College of Anaesthetists, Airway Management Special Interest Group and is currently being promoted for adoption across Australia and New Zealand. A solution for private hospitals is being sought and the development of a national database is proposed.

The network has been invited to present the Difficult Airway Alert at the International Airway Conference in Kuala Lumper in March 2019.

The project won the Enabling Safe, Quality Services and High Performance Category at the 2018 Queensland Health Awards for Excellence.

Key dates
Feb 2018
Dec 2019
Implementation sites
Currently all Queensland Health public facilities
Public and private hospitals across Queensland, Australian and New Zealand College of Anaesthetists and more recently the EDMS forum, QEDSAP and statewide intensive care network


The Difficult Airway Alert form and glossary of terms were developed to support the registration of a difficult airway event and provide clinicians with vital information (i.e. history of the patients previous airway related treatment) to enable them to provide safe care and deliver improved outcomes in this cohort of patients.


The Difficult Airway Alert (first of its kind in Australia) is a concise and effective communication tool to support the registration of a difficult airway event and reduce the risk of future airway morbidity in at risk patients.


The Difficult Airway Alert was developed in response to a number of airway related incidents in Queensland. There is significant variation in practice within the public and private sectors across the state.

Solutions Implemented

  • Website developed.
  • Roll out to Queensland public hospitals is underway.
  • ieMR version under development - to be completed by February 2019.
  • Presented to the EDMS forum.
  • Supported by the Queensland Health, Chief Health Officer, Queensland Emergency Department Special Advisory Panel and Statewide Intensive Care Clinical Network.
  • Endorsed by the Queensland Health Clinical Data Standards Working Group and supported by the Management Strategic Governance Committee.
  • Inclusion of the Difficult Airway Alert and definition in the SNOMED data set.
  • Endorsed by the Australian and New Zealand College of Anaesthetists and presented at their national conference in Adelaide in October 2018.
  • Mater Health Service trial to commence in February 2019.

Evaluation and Results

To be developed into a statewide database and a national database in due course.

Lessons Learnt

Inclusion of all stakeholders in the consultation process from the outset is paramount to acceptance and success.


1. Bradley P, et al. Airway Assessment. ANZCA, 2016. www.anzca.edu.au/documents/pu-airway-assessment-20160916v1.pdf
2. Baker P, et al. How do anaesthetists in New Zealand disseminate critical airway information? Anaesth Intensive Care 2013; 41:334–41
3. Han R, et al. Grading scale for mask ventilation. Anesthesiology, 2004; 101(1):267
4. Cormack R & Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia. 1984; 39(11):1105–11
5. Clinical Excellence Division, Queensland Health 2018
6. Cook T. A grading system for direct laryngoscopy. Anaesthesia. 1999; 54(5):496–7
7. Levitan R et al. A grading system for direct laryngoscopy. Anaesthesia. 1999; 54(10):1009–10
8. Shaeuble J & Ganter M. Clarifying the indications for difficult airway alert forms. Anaesthesia. 2015; 70(4):505–6

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Key contact

Karen Hamilton
Principal Project Officer
Healthcare Improvement Unit
(07) 3328 9164