Navigating Through Human Factor Elements in Airway Management: A Qualitative Study of Current Trends in Intubation Practices

Sheeba Franklin; Nirmala Mathew

doi:10.55489/njmr.160420261378

Authors

Sheeba Franklin Department of Anesthesiology, Government Medical College, Kottayam, Kerala, India
Nirmala Mathew Department of Anesthesiology, Government Medical College, Kottayam, Kerala, India

DOI:

https://doi.org/10.55489/njmr.160420261378

Keywords:

Anesthesia, Human factor, Endotracheal intubation, Safe practice, Clinical decision making

Abstract

Background: Difficult airway management requires appropriate assessment, planning, technical skills, teamwork, and effective use of cognitive aids. Human factors may influence decision-making during challenging airway situations. This study explored the experiences of airway practitioners and identified facilitators and barriers in routine airway instrumentation using the SEIPS framework.

Methods: A qualitative study using thematic analysis based on Braun and Clarke’s approach was conducted at a tertiary care center in Kottayam, Kerala. Fifteen anaesthesiologists or emergency physicians with at least five years of airway-management experience were purposively selected. Data were collected through in-depth face-to-face interviews conducted between October 2024 and October 2025. Interviews were transcribed and analyzed using an inductive approach, with themes and subthemes developed and reviewed by the investigators.

Results: Three initial codes, five major themes, and 15 subthemes emerged from the interviews. The major themes were clinical and problem-solving skills, training and teamwork, overcoming challenges, the role of tools in clinical decision-making, and sources of error in clinical decisions. Participants emphasized appropriate airway assessment, timely decision-making, teamwork, supervision, access to advanced airway devices, updated knowledge, and effective communication. Uncertainty from previous experiences, overconfidence, cognitive overload, poor communication, and system-related constraints were identified as barriers.

Conclusion: Standardization, updated knowledge, teamwork, leadership, effective communication, and appropriate cognitive aids may help address challenges in airway management and bridge gaps between policy and clinical practice.

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