Evaluating the quality improvement impact of the Global Tracheostomy Collaborative in four diverse NHS hospitals

Abstract

Tracheostomies are predominantly used in Head & Neck Surgery and the critically ill. The needs of these complex patients frequently cross traditional speciality working boundaries and locations and any resulting airway problems can rapidly lead to significant harm. The Global Tracheostomy Collaborative (GTC) was formed in 2012 with the aim of bringing together international expertise in tracheostomy care in order to bring about rapid adoption of best practices and to improve the quality and safety of care to this vulnerable group.The primary aim of this project was to improve the safety and quality of care delivered to adult patients with new or existing tracheostomies. We implemented changes guided by the GTC using multiple PDSA cycles over a 12-month period. Interventions were across three themes: educational, patient-centred (earlier vocalisation and enteral intake) and organisational. We hypothesised that systematic healthcare improvements would reduce the severity of harm resulting from tracheostomy-related safety incidents and improve surrogate markers of the quality of patient-centred care. Furthermore, we hypothesised that raising the quality and safety of healthcare services would lead to more efficient care, measured by earlier tracheostomy decannulation times and reduced hospital lengths of stay.This Quality Improvement project implemented the GTC into four diverse NHS Trusts in Greater Manchester. Key drivers implemented included multidisciplinary tracheostomy steering groups, ward rounds and bedside teams, standardisation of tracheostomy protocols, staff education and meaningful involvement of patient and family. Surrogates for the quality and safety of care were captured for all patients using a bespoke database.Implementing the GTC into four NHS Trusts rapidly and positively impacted on patient safety metrics and surrogates for the quality of care delivered. It is likely that the comprehensive resources of the GTC will be of benefit to other NHS hospitals and indeed other healthcare systems around the world.

Multidisciplinary guidelines for the management of paediatric tracheostomy emergencies

“…While the primary aim of these guidelines is to improve the emergency management of paediatric tracheostomy emergencies, wider developments include addressing the safety and quality of care, with the aim of reducing the incidence of airway emergencies. Initiatives such as the Global Tracheostomy (Quality Improvement) Collaborative (http://www.globaltrach.org) can support organisational improvements and by collecting patient‐level metrics, quantify the effectiveness of care bundles, protocols, and of training, equipping and supporting staff in delivering high‐quality care . Improving transitional and community paediatric tracheostomy care may also improve the safety and quality of care and reduce emergency department visits .…”

Mortality associated with tracheostomy complications in the United States: 2007–2016

“…The Global Tracheostomy Collaborative (GTC) includes 45 member hospitals around the world working to eliminate catastrophic tracheostomy‐related events and improving the lives of patients with a tracheostomy. Implementation of GTC drivers decreased length of stay across four National Health Service hospitals . Some authors have suggested that tracheostomy‐related catastrophic events might be considered never events, as most events involve absence of preventive/rescue measures or shortfalls in training and staffing .…”

“…Implementation of GTC drivers decreased length of stay across four National Health Service hospitals. 25 Some authors have suggested that tracheostomy-related catastrophic events might be considered never events, as most events involve absence of preventive/rescue measures or shortfalls in training and staffing. 26 Although some causes of tracheostomy-related mortality, such as tracheoinnominate fistula, are very difficult to prevent, others, such as tracheotomy wounds, have been characterized as never events based on analogy to decubital ulcers.…”

Better tracheostomy care through targeted education using social media

“…The National Tracheostomy Safety Project (NTSP) has published strategies to manage and prevent airway emergencies in patients with tracheostomies and laryngectomies. 1,2 However, front-line healthcare professionals most likely to benefit from guidance may not have access to or are unlikely to read publications in traditional medical literature. To improve dissemination of such guidelines, The Health Foundation launched Evidence into Practice in 2017.…”

“…The Portsmouth physiological and operative severity score for the enumeration of mortality (P-POSSUM), surgical risk scale (SRS), and surgical outcome risk tool (SORT) have previously been used to predict 30-day perioperative mortality. 1,2 However, their accuracy compared with clinical judgement alone remains unknown.…”