Are we ‘on the right trach?’ The National Confidential Enquiry into Patient Outcome and Death examines tracheostomy care

Abstract

Objectives: The National Confidential Enquiry into Patient Outcome and Death presents a detailed survey of practice, encompassing the care pathway for patients with a new tracheostomy formed in hospital, alongside a review of organisational aspects of care.Results: Tracheostomy formation has come to be regarded as a relatively low-risk procedure that can be carried out safely at the bedside, even in high-risk patients. Information on how many procedures are carried out percutaneously has been poor and not captured by existing UK data collection systems.Conclusion: The study reinforces recommendations made by other healthcare groups, and presents new information which can be used as a basis for discussion and future planning to improve patient outcomes. The importance of meticulous ongoing care of a tracheostomy is recognised as important to prevent patient complications. Bedside staff must have the knowledge, competencies and confidence to deal with common and potentially life-threatening emergencies when they occur.

Practice and bias in intraoperative pain management: results of a cross-sectional patient study and a survey of anesthesiologists

“… 42 However, these considerations are not supported by clinical evidence as perioperative pain in the elderly is often underestimated and their analgesic needs have shown to be similar to that of younger patients. 42 , 43 Furthermore, women are known to experience more pain and require additional analgesics postoperatively compared with men. 44 This base rate was translated into practice here with female patients receiving higher doses of morphine.…”

Buying time with THRIVE

“…Whilst generally regarded as a safe procedure, the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) review of tracheostomies highlighted significant deficiencies in postinsertion care [9]. Whilst generally regarded as a safe procedure, the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) review of tracheostomies highlighted significant deficiencies in postinsertion care [9].…”

“…These potential risks mean that, in the past, when presented with significant supraglottic pathology, head and neck teams have often resorted to 'prophylactic' tracheostomy. Whilst generally regarded as a safe procedure, the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) review of tracheostomies highlighted significant deficiencies in postinsertion care [9]. This, coupled with a significant psychological impact for both patients and their families, means that, where possible, tracheostomy insertion should ideally be avoided [10].…”

Focus on tracheostomy

“…An important review article in this issue by the National Confidential Enquiry into Patient Outcome and Death ('NCEPOD') in the UK examines current practice in tracheostomy. 1 The emergence of percutaneous tracheostomy techniques used by critical care doctors has changed the scope of this operation, with the majority (69.6 per cent) of procedures being undertaken in this way in the UK during the survey period. Surgical tracheostomy continues to be undertaken on those patients unsuitable for percutaneous techniques.…”