Improving tracheostomy care in the United Kingdom: results of a guided quality improvement programme in 20 diverse hospitals

McGrath, Brendan A.; Wallace, Sarah; Lynch, James C.; Bonvento, Barbara; Coe, Barry; Owen, Anna; Firn, Mike; Brenner, Michael; Edwards, Elizabeth; Finch, Tracy; Cameron, Tanis; Narula, A.; Roberson, David W.

doi:10.1016/j.bja.2020.04.064

Cited by 69 publications

(84 citation statements)

References 29 publications

(21 reference statements)

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“…Safe and high-quality care can be provided in various settings. 39,40 However, because of the risk of viral transmission, the concept of patient-centred care must be balanced against the safety of health-care workers. Patients need to be managed by experienced staff who are trained in tracheostomy care and management.…”

Section: Optimal Management After Tracheostomymentioning

confidence: 99%

Tracheostomy in the COVID-19 era: global and multidisciplinary guidance

McGrath

Brenner

Warrillow

et al. 2020

The Lancet Respiratory Medicine

362

500

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Global health care is experiencing an unprecedented surge in the number of critically ill patients who require mechanical ventilation due to the COVID-19 pandemic. The requirement for relatively long periods of ventilation in those who survive means that many are considered fxor tracheostomy to free patients from ventilatory support and maximise scarce resources. COVID-19 provides unique challenges for tracheostomy care: health-care workers need to safely undertake tracheostomy procedures and manage patients afterwards, minimising risks of nosocomial transmission and compromises in the quality of care. Conflicting recommendations exist about case selection, the timing and performance of tracheostomy, and the subsequent management of patients. In response, we convened an international working group of individuals with relevant expertise in tracheostomy. We did a literature and internet search for reports of research pertaining to tracheostomy during the COVID-19 pandemic, supplemented by sources comprising statements and guidance on tracheostomy care. By synthesising early experiences from countries that have managed a surge in patient numbers, emerging virological data, and international, multidisciplinary expert opinion, we aim to provide consensus guidelines and recommendations on the conduct and management of tracheostomy during the COVID-19 pandemic.

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Section: Optimal Management After Tracheostomymentioning

confidence: 99%

Tracheostomy in the COVID-19 era: global and multidisciplinary guidance

McGrath

Brenner

Warrillow

et al. 2020

The Lancet Respiratory Medicine

362

500

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“…It will be critical for future studies to track data in tracheostomy care, as is done for example in the Global Tracheostomy Collaborative. [23][24][25] These data are already starting to emerge. For example, a national cohort study from Spain recently published their experience with 1890 COVID-19 tracheostomies.…”

Section: Variation In Practicesmentioning

confidence: 99%

Tracheostomy During the COVID‐19 Pandemic: Comparison of International Perioperative Care Protocols and Practices in 26 Countries

Bier‐Laning

Cramer

Roy

et al. 2020

Otolaryngol.--head neck surg.

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Objective The coronavirus disease 2019 (COVID-19) pandemic has led to a global surge in critically ill patients requiring invasive mechanical ventilation, some of whom may benefit from tracheostomy. Decisions on if, when, and how to perform tracheostomy in patients with COVID-19 have major implications for patients, clinicians, and hospitals. We investigated the tracheostomy protocols and practices that institutions around the world have put into place in response to the COVID-19 pandemic. Data Sources Protocols for tracheostomy in patients with severe acute respiratory syndrome coronavirus 2 infection from individual institutions (n = 59) were obtained from the United States and 25 other countries, including data from several low- and middle-income countries, 23 published or society-endorsed protocols, and 36 institutional protocols. Review Methods The comparative document analysis involved cross-sectional review of institutional protocols and practices. Data sources were analyzed for timing of tracheostomy, contraindications, preoperative testing, personal protective equipment (PPE), surgical technique, and postoperative management. Conclusions Timing of tracheostomy varied from 3 to >21 days, with over 90% of protocols recommending 14 days of intubation prior to tracheostomy. Most protocols advocate delaying tracheostomy until COVID-19 testing was negative. All protocols involved use of N95 or higher PPE. Both open and percutaneous techniques were reported. Timing of tracheostomy changes ranged from 5 to >30 days postoperatively, sometimes contingent on negative COVID-19 test results. Implications for Practice Wide variation exists in tracheostomy protocols, reflecting geographical variation, different resource constraints, and limited data to drive evidence-based care standards. Findings presented herein may provide reference points and a framework for evolving care standards.

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“…Slow dissemination of best practices has been a major barrier to high quality tracheostomy care, despite the notable successes of multidisciplinary tracheostomy care. 1 - 4 A critical knowledge gap in the United States and abroad 5 is how to drive large-scale improvement in care. These data are critically important for quality improvement and clinical education.…”

Section: Introductionmentioning

confidence: 99%

Multidisciplinary Tracheostomy Quality Improvement in the COVID-19 Pandemic: Building a Global Learning Community

Swords

Bergman

Wilson-Jeffers

et al. 2020

Ann Otol Rhinol Laryngol

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Objectives: To report experience with a global multidisciplinary tracheostomy e-learning initiative Methods: An international multidisciplinary panel of experts convened to build a virtual learning community for tracheostomy care, comprising a web-based platform, five distance learning (interactive webinar) sessions, and professional discourse over 12 months. Structured pre- and post-webinar surveys were disseminated to global participants including otolaryngologists, intensivists, nurses, allied health professionals, and patients/caregivers. Data were collected on audio-visual fidelity, demographics, and pre- and post-tutorial assessments regarding experience and skill acquisition. Participants reported confidence levels for NICU, pediatric, adult, and family care, as well as technical skills, communication, learning, assessment, and subdomains. Results: Participants from 197 institutions in 22 countries engaged in the virtual education platform, including otolaryngologists, speech pathologists, respiratory therapists, specialist nurses, patients, and caregivers. Significant improvements were reported in communication ( P < .0001), clinical assessments ( P < .0001), and clinical governance ( P < .0001), with positive impact on pediatric decannulation ( P = .0008), adult decannulation ( P = .04), and quality improvement ( P < .0001). Respondents reported enhanced readiness to integrate knowledge into practice. Barriers included time zones, internet bandwidth, and perceived difficulty of direct clinical translation of highly technical skills. Participants rated the implementation highly in terms of length, ability for discussion, satisfaction, applicability to professional practice, and expertise of discussants (median scores: 4, 4, 4, 4 and 5 out of 5). Conclusions: Virtual learning has dominated the education landscape during COVID-19 pandemic, but few data are available on its effectiveness. This study demonstrated feasibility of virtual learning for disseminating best practices in tracheostomy, engaging a diverse, multidisciplinary audience. Learning of complex technical skills proved a hurdle, however, suggesting need for hands-on experience for technical mastery. While interactive videoconferencing via webinar affords an engaging and scalable strategy for sharing knowledge, further investigation is needed on clinical outcomes to define effective strategies for experiential online learning and virtual in-service simulations.

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Improving tracheostomy care in the United Kingdom: results of a guided quality improvement programme in 20 diverse hospitals

Cited by 69 publications

References 29 publications

Tracheostomy in the COVID-19 era: global and multidisciplinary guidance

Tracheostomy in the COVID-19 era: global and multidisciplinary guidance

Tracheostomy During the COVID‐19 Pandemic: Comparison of International Perioperative Care Protocols and Practices in 26 Countries

Multidisciplinary Tracheostomy Quality Improvement in the COVID-19 Pandemic: Building a Global Learning Community

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