Enhancing care of patients requiring a tracheostomy: A sustained quality improvement project

Abstract

Introduction: Within the UK approximately 5000 surgical and 12,000 percutaneous tracheostomies are performed annually. Whilst an essential component of patient care, the presence of a tracheostomy is not without concern. Landmark papers have demonstrated recurrent themes related to the provision of training, staff and equipment, leading to avoidable patient harm, life-altering morbidity and mortality. The development of the Global Tracheostomy Collaborative (GTC) and the Improving Tracheostomy Care (ITC) project have provided the necessary infrastructure to make improvements, with individual organizations responsible for its implementation.

Method: This quality improvement project, funded by the NHS Wales Critical Care and Trauma Network, developed a dedicated tracheostomy team to improve the quality of care provided to those patients requiring a tracheostomy through staff education, equipment standardisation and multidisciplinary tracheostomy ward rounds. Global Tracheostomy membership was funded through involvement in the ITC project.

Results: Formal tracheostomy teaching was delivered by the tracheostomy team to 165 clinicians involved in tracheostomy care. Improvements in self-assessed confidence with knowledge and were observed for all aspects of tracheostomy care. Standardisation and centralisation resulted in reduction in waste and unnecessary variation. Compliance with 'emergency tracheostomy blue box' availability with an increase from 5% to 100%. Comparison of data from the QI period against baseline data, demonstrated improvement in rates of decannulation, and non-significant improvements in time to decannulation, critical care and hospital length of stay. Additionally, there were associated reductions in adverse events.

Conclusion: This QI project, supported by involvement with the GTC and ITC, resulted in reductions in adverse events, improved patient safety, non-significant reduction in time to achieve weaning milestones and a reduction in hospital length of stay.