RAFT 5: SECURE

About S.E.C.U.R.E

RAFT 5: S.E.C.U.R.E. is a UK wide, cross-specialty service evaluation of Rapid Sequence Intubation (RSI) events. Setting: All acute hospitals within the UK Population: All adult populations (18 years or older) Aim: S.E.C.U.R.E. aims to define the perceived indications for, specific techniques used in and the immediate complications of Rapid Sequence Intubation events (RSIs) in current UK in-hospital practice across anaesthesia, critical care and emergency medicine. Practically SECURE will consist of three stages - a site survey, an activity survey and clinical vignettes.

SITE SURVEY

01-31st March

A UK-wide audit looking at RSI resources, infrastructure and governance.

Covers all acute clinical areas.

All clinical populations >18yo

What tools do we have at our disposal when conducting RSI?

SITE SURVEY

ACTIVITY SURVEY

13th April - 25th May

An observational study recording RSI practice across all specialities, at each site.

What is RSI practice today?

CLINICAL VIGINETTE

01-30th June

A survey investigating individual perceptions around RSI practice in the UK.

Is there a say-do gap when it comes to modified RSI?

MORE ABOUT THE PROJECT

Why are we doing SECURE? Pre-specified hypothesis: It is likely that there will emerge both centre-specific and specialty-specific differences in the conduct of RSIs across the UK. The broader why question: In the Pamela Marking: Prevention of Future Deaths Report. The coroners concerns listed RSI practice as one of the key areas which may have contributed to her death. Notably the concerns included: (A) A lack of ‘Updated’ National Guidelines for Rapid Sequence Induction (RSI) of Anaesthesia for emergency surgery (B) Lack of ‘Updated’ National Guidelines to support the use of TIVA for RSI (C) Lack of ‘Updated’ Guidelines for use of Cricoid pressure and other measures to protect the airway in a RSI anaesthetic. Link: https://www.judiciary.uk/prevention-of-future-death-reports/pamela-marking-prevention-of-future-deaths-report/ SECURE will give some baseline data on current modified RSI practice in the UK today. This might help guide national standards regarding RSIs going forward.

Aim: SECURE aims to define the perceived indications for, specific techniques used in and the immediate complications of RSIs in current UK in-hospital practice across anaesthesia, critical care and emergency medicine. Specific objectives • Describe what specific equipment, protocols and training related to RSI are in place in different clinical areas across different UK acute hospital sites. • Describe, through the use of clinical vignettes, practitioner self reported RSI practice in the UK. • Describe, through observational study, current RSI practice in the UK, across different specialties and in different clinical areas. • Identify if observed practice is in line with practitioner self-reported practice, or if a “say-do gap” exists. • Compare self reported practice, observed practice, and site provision of equipment/protocols/training with international recommendations on RSI practice (PUMA guidelines - Project for Universal Management of the Airway) • Describe incidence of pre-specified complications associated with RSI, and identify specific components of practice and/or patient factors associated with these through case reviews.

HOW TO GET INVOLVED

Contact your local research group (or TERN if an ED trainee!) and let them know you'll be interested. Recruitment of site leads and collaborators begins in December!