Implementation of a Hospital-Wide Difficult Airway Group: A Quality Improvement and Feasibility Report Across Clinical, Organizational, Educational and Resource Domains.

Airway management is essential to most anaesthetic procedures but remains associated with significant morbidity and mortality when complications occur. National audits have highlighted the im- portance of system-based approaches to improve airway safety. In response, institutional initiatives such as Difficult Airway Groups (DAG) have been proposed. We conducted a quality improvement and feasibility study evaluating the implementation of a DAG in a tertiary university hospital. The programme was structured across four domains: organizational, clinical, educational and resource. A retrospective analysis of all DAG consultations over a three-month period (1 July – 30 September 2025) was performed to describe early activity and feasibility. During the study period, 25 cases were managed, predominantly anticipated difficult airways. Most requests originated from the Department of Anaesthesiology (88%), with additional activations from the Intensive Care Unit (8%) and Emergency Department (4%). Awake techniques were favoured, with awake fibreoptic intubation being the most frequently used approach (40%). Airway management was successful in 96% of cases, with no airway-related mortality, unplanned surgical airways or severe complications. These findings primarily reflect early implementation and feasibility outcomes. The implementation of a hospital-wide DAG appears feasible and enables coordinated management of complex airways. Early feasibility indicators of the programme were observed. However, these represent very early implementation data, based on a limited number of cases and a short observation period. Further studies with larger cohorts, longer follow-up and comprehensive outcome metrics are required to evaluate the long-term clinical impact and sustainability of this model. • Successful Implementation of a hospital-wide Difficult Airway Group (DAG) appears feasible in a tertiary hospital setting. • Early clinical results suggest high procedural success without major airway-related complications, supporting the safe application of structured difficult airway strategies. • Further studies with larger cohorts, longer follow-up and comprehensive outcome metrics are required to evaluate the long-term clinical impact and sustainability of this model.