Authors (including presenting author) :
Chan WTT(1)(2)(3), Lui CT(1)(2)(3), Chan YW(1)
Affiliation :
(1) Department of Accident & Emergency, Tuen Mun Hospital, (2) Department of Accident & Emergency, Pok Oi Hospital, (3) Department of Accident & Emergency, Tin Shui Wai Hospital
Keyword 1: :
Direct laryngoscope
Introduction :
Performing intubation with direct laryngoscopes (DL) has been a basic airway skill for decades, but our practice has changed since COVID-19 pandemic. Doctors have switched to use videolaryngoscopes (VL) routinely for all initial intubation attempts. Trainees or new specialists have lost the capability to use DL for intubation. It poses potential risks to patient care. There are settings that VL is not immediately available, such as on ambulance or in general ward. A competent emergency physician should harbor the skill of DL in all circumstances. Moreover, the cost of VL operation, including disposable components, are far compared with DL.
Objectives :
1) Rebuild the competency of using DL for intubation through structural training 2) Facilitate experience acquisition on DL use at bedside and reduce the use of VL for first attempt intubation
Methodology :
The "DL First” campaign was launched in our department in three hospitals in September 2025. Structural and simulation training had been conducted to physicians. Concurrent training was provided on airway equipment preparation to frontline nurses. The practice of using DL first for non-difficult airway and non-infectious patients was promulgated in department training meetings. A taskforce was formed in each hospital to provide training to trainees and young specialists, including DL techniques, bimanual laryngoscopy and the use of bougie. Training was delivered in multiple formats, including online videos and face-to-face coaching. To measure the outcome, consumption of disposable VL blades was calculated every 2 months since September 2025. The goal was to reduce VL blade consumption by at least 50% after the first 2 months, using the consumption in 2024 as reference.
Result & Outcome :
In 2024, there were totally 1729 disposable VL blades used in the emergency departments of the three hospitals (average 289 every 2 months). After the programme was launched, there was up to 66% reduction in use of VL blades, with only 99 consumed in 2 months. Majority of trainees and fellows reported positive feedback with perceived similar first-attempt success rate. The estimated annual spendings on disposable VL blades of the three emergency departments would be reduced from $771,414 to $288,612. The campaign has been successful at rebuilding skills of DL use in uncomplicated airway, achieving both enhanced competency of practicing physicians as well as positive impact on financing.
