Identifying and Improving Knowledge Deficits of Emergency Airway Management of Tracheotomy and Laryngectomy Patients: A Pilot Patient Safety Initiative

Abstract

Objectives. To evaluate the knowledge base of hospital staff regarding emergent airway management of tracheotomy and laryngectomy patients, and the impact of the introduction of a bedside airway form. Methods. Cross-sectional surveys of physicians, nurses, and respiratory therapists at a tertiary care hospital prior to and 24 months after introduction of a bedside Emergency Airway Access (EAA) form. Results. Pre- and postintervention surveys revealed several knowledge deficits. Preintervention, 37% of medical internists and 19% overall did not know that laryngectomy patients cannot be orally ventilated, and 67% of internists could not identify the purpose of stay sutures in recently created tracheotomies. Postintervention, these numbers improved for all groups. Furthermore, 80% of respiratory therapists reported encountering the EAA form in an emergent situation and found it useful. Conclusion. A knowledge deficit is identified in caregivers expected to provide emergency management of patients with airway anatomy altered by subspecialty surgeons. Safety initiatives such as the EAA form may improve knowledge among providers.

Healthcare professionals' knowledge, attitudes and skills regarding patient safety: a systematic literature review

“…Statistically significant effects on nurses' knowledge of pressure ulcers were also reported . Following the implementation of an airway form, the postintervention knowledge of all participants concerning the ventilation of laryngectomy patients was also improved . Internists improved their knowledge by identifying the purpose of stay sutures in recently created tracheostomies , and surgeons showed a significant improvement in their knowledge of patient safety, following a half‐day training programme (mean pre = 45.26% vs mean post = 70.59%, p < 0.01) .…”

“…Significant knowledge deficits were highlighted in physicians regarding the QT interval and QTprolonging medications, in which less than two-thirds (63%) of respondents were able to accurately identify possible QT-prolonging medications, and only about half (51%) could accurately identify medication combinations that might prolong the QT interval (40). Medical internists and nurses were also highlighted as not knowing that laryngectomy patients cannot be orally ventilated, and internists could not identify the purpose of stay sutures in recently created tracheostomies (41). Knowledge improvements were found in the contexts of the prevention of either specific issues or the general improvement of patient safety.…”

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

“…15 Risk calculators for critically ill patients also predict the risk of mortality following tracheostomy poorly in HNC patients. 15 A separate issue for HNC patients is death due to confusion between a laryngectomy stoma and a tracheostomy with attempted orotracheal intubation, 16 which could not be studied in the present data.…”

The UK National Tracheostomy Safety Project and the role of speech and language therapists

“…However, morbidity and mortality directly attributable to the tracheostomy also occur. The likelihood and nature of any subsequent patient harm depends on the underlying condition of the patient, the nursing and medical infrastructure available for both routine and emergency care and the patient location at the time of the incident [12][13][14][15][16][17][18]. Figure 1 demonstrates that more adequately supported ICU patients suffered less harm than ward patients following common tracheostomy emergencies.…”