The Global Tracheostomy Collaborative: one institution's experience with a new quality improvement initiative

Lavin, Jennifer; Shah, Rahul K.; Greenlick, Hannah; Gaudreau, Philip; Bedwell, Joshua R.

doi:10.1016/j.ijporl.2015.11.024

Cited by 23 publications

(12 citation statements)

References 11 publications

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“…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 .…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary guidelines for the management of paediatric tracheostomy emergencies

et al. 2018

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Summary Temporary and permanent tracheostomies are required in children to manage actual or anticipated long‐term ventilatory support, to aid secretion management or to manage fixed upper airway obstruction. Tracheostomies may be required from the first few moments of life, with the majority performed in children < 4 years of age. Although similarities with adult tracheostomies are apparent, there are key differences when managing the routine and emergency care of children with tracheostomies. The National Tracheostomy Safety Project identified the need for structured guidelines to aid multidisciplinary clinical decision making during paediatric tracheostomy emergencies. These guidelines describe the development of a bespoke emergency management algorithm and supporting resources. Our aim is to reduce the frequency, nature and severity of paediatric tracheostomy emergencies through preparation and education of staff, parents, carers and patients.

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Section: Discussionmentioning

confidence: 99%

Multidisciplinary guidelines for the management of paediatric tracheostomy emergencies

et al. 2018

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“…Prospectively collecting outcome data on a large scale via an international, multiinstitutional HIPAA-compliant database will eventually allow for benchmarks to be set and for novel targets for quality improvement initiatives to be identified. 119 This will help to define and refine tracheostomy care best practices. The database contains branching logic to collect data specific to both adult and pediatric patients with tracheostomy.…”

Section: Global Tracheostomy Collaborativementioning

confidence: 99%

“…To date, the database has recorded the data of Ͼ1,500 patients with tracheostomy since August 2015, and member hospitals receive biannual reports of their data. 119 As the use of this collaborative database grows, tracheostomy care best practices can be refined and disseminated, and new targets for quality improvement may be identified.…”

Section: Global Tracheostomy Collaborativementioning

confidence: 99%

Tracheostomy in Infants and Children

2017

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Over the last decade, tracheostomy has been increasingly performed in children, aligned with the improvements in neonatal and pediatric ICU care. Nowadays, the majority of children with tracheostomy represent a very complex cohort of patients with sustained reliance on tracheostomy and related medical technology for long-term survival. Tracheostomy is one of the most commonly performed procedures in the adult ICU. Contrary to adult practice, tracheostomy is a much less common procedure in the pediatric ICU, being performed in < 3% of patients. There is no definite consensus about the length of time a child should remain endotracheally intubated before the placement of a tracheostomy. Tracheostomy in children also continues to remain a predominantly surgical procedure, with percutaneous tracheostomy being performed infrequently and only considered feasible in older children. The indications, preoperative considerations, and procedure types for tracheostomy in children are reviewed. There is also a lack of consensus on an optimal pediatric decannulation protocol. The literature discusses a myriad of protocols that use varying combinations of in-patient/out-patient resources, specialized tests, and procedures An ideal decannulation protocol is presented, as well as review of recently published decannulation algorithms. Finally, children with tracheostomy have a higher risk of adverse events and mortality, which are largely secondary to their comorbidities rather than the tracheostomy. The majority of the tracheostomy-related events are in fact potentially preventable. There is a recognized need for improvement and coordination of care of pediatric patients with tracheostomy. A multidisciplinary coordinated approach to tracheostomy care has already shown promising results. This paper seeks to review the pertinent literature regarding quality improvement initiatives for tracheostomy care, including review of the recently established Global Tracheostomy Collaborative.

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“…The Global Tracheostomy Collaborative (GTC) is working to improve outcomes in tracheostomy care by developing best practices and standardization of care . This study may help their effort by demonstrating that increased tracheostomy manipulation within the first 2 weeks is a risk factor for tracheostomy related complications.…”

Section: Discussionmentioning

confidence: 99%

“…Pediatric tracheostomy is associated with a low overall incidence of procedure related morbidity. [3][4][5][6][7][8][9] Complications are typically related to multiple comorbidities in this medically complex patient population. 3,5,7,10 However, when tracheostomy related complications occur, the consequences can be severe.…”

Section: Discussionmentioning

confidence: 99%

Tracheostomy manipulations: Impact on tracheostomy safety

Espinel

Scriven

Shah

2019

Pediatric Investigation

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Importance Tracheotomy is one of the riskiest procedures for composite morbidity within pediatric otolaryngology. During the postoperative period, each time the tracheostomy tube is manipulated, there is opportunity for morbidity (e.g. a patient is vulnerable to accidental decannulation and airway loss). Objective To identify areas of improvement in caring for “fresh tracheostomy” patients by determining the number of times a tracheostomy tube is manipulated from placement until discharge. The hypothesis is that the more a tracheostomy is manipulated, the higher probability of morbidity. Methods A quality improvement initiative was conducted to map the care of patients who underwent tracheostomy placement over 12 months. Tracheostomy care and manipulation by all providers were reviewed. Complications, wound care, and respiratory treatments were also evaluated. Results Patients were hospitalized for an average of 39 days (7–140) following tracheostomy. The first tracheostomy tube change occurred on average 6 days (5–10) following placement. Tracheostomy tubes were manipulated an average of 6 (2.5–11.9) times a day to amount to 216 (51–1091) times between placement and discharge. Bedside nurses and respiratory therapists were responsible for 95% of these actions; physicians accounted for 4%. There were 6 tracheostomy related complications. Three were accidental decannulations resulting in cardiopulmonary arrest. One of these caused long term patient morbidity. Patients with more than 4 manipulations per day during the 2 weeks following tracheostomy tube placement, were more likely to have a tracheostomy related complication than those with less than 4 (OR: 12.5; 95% CI: 1.2–130.6; P = 0.0349). Interpretation While uncommon, complications related to tracheostomy can have serious long term effects and at best prolongs length of stay for patients. Reducing the number of tracheostomy manipulations may provide safer postoperative care ultimately reducing morbidity and potentially mortality; children on average have 6 tracheotomy manipulations/day with only 2% being by the physician.

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The Global Tracheostomy Collaborative: one institution's experience with a new quality improvement initiative

Cited by 23 publications

References 11 publications

Multidisciplinary guidelines for the management of paediatric tracheostomy emergencies

Multidisciplinary guidelines for the management of paediatric tracheostomy emergencies

Tracheostomy in Infants and Children

Tracheostomy manipulations: Impact on tracheostomy safety

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