Comparison of self-reporting of deficiencies in airway management with video analyses of actual performance

We compared the performance deficiencies of airway management captured by three types of self-reports with those identified through video analysis. The three types of self-reports were the anesthesia record (a patient record constructed during the course of treatment), the anesthesia quality assurance (AQA) report (a retrospective report as a part of the trauma center's quality assurance process), and a posttrauma treatment questionnaire (PTQ), which was completed immediately after the case for the purposes of this research. Video analysis of 48 patient encounters identified 28 performance deficiencies related to airway management in 11 cases (23%). The performance deficiencies took the form of task omissions or practices that lessened the margin of patient safety. In comparison, AQA reports identified none of these performance deficiencies, the anesthesia records identified 2 (of 28), and the PTQs suggested contributory factors and corrective measures for 5 deficiencies. Furthermore, video analysis provided information about the context of and factors contributing to the identified performance deficiencies, such as failures in adherence to standard operating procedures and in communications.