Translation of national guidelines into local practice.

Background: Addressing themes raised by the Royal College of Anaesthetists National Audit Project 4, we introduced new training programmes to improve the knowledge and skills necessary for the management of airway crises. A further large-scale multimodal training programme was introduced to implement guidelines published in 2015 by the Difficult Airway Society (DAS).

Methods: In 2014, questionnaires were used to assess the knowledge necessary to manage the unanticipated difficult airway before and after high-fidelity simulation sessions. In 2016, surveys assessed knowledge of new DAS guidelines before and 5 months after the implementation of a large-scale targeted teaching programme to educate staff.

Results: In 2014, 20 anaesthetic teams (75 delegates) attended high-fidelity simulations and demonstrated a significant immediate improvement in knowledge. In 2016, 185 participants attended a targeted teaching programme. Although after the teaching programme an increased number of anaesthetists reported having accessed training, there was a persistent knowledge gap, with some details retained by as few as 15% of participants.

Discussion: Whereas the knowledge of these important guidelines was improved in the immediate aftermath of high-fidelity simulation training, the knowledge retention was disappointing, raising questions as to why knowledge of highly important techniques used in crises was so poor. We ask whether training should be compulsory and how knowledge retention might be improved across all health care disciplines that rely on guidelines for the effective management of rarely occurring but safety-critical events.