The Trach Trail: A Systems‐Based Pathway to Improve Quality of Tracheostomy Care and Interdisciplinary Collaboration

Abstract

Objective To implement a standardized tracheostomy pathway that reduces length of stay through tracheostomy education, coordinated care protocols, and tracking patient outcomes. Methods The project design involved retrospective analysis of a baseline state, followed by a multimodal intervention (Trach Trail) and prospective comparison against synchronous controls. Patients undergoing tracheostomy from 2015 to 2016 (n = 60) were analyzed for demographics and outcomes. Trach Trail, a standardized care pathway, was developed with the Iowa Model of Evidence-Based Practice. Trach Trail implementation entailed monthly tracheostomy champion training at 8-hour duration and staff nurse didactics, written materials, and experiential learning. Trach Trail enrollment occurred from 2018 to 2019. Data on demographics, length of stay, and care outcomes were collected from patients in the Trach Trail group (n = 21) and a synchronous tracheostomy control group (n = 117). Results Fifty-five nurses completed Trach Trail training, providing care for 21 patients placed on the Trach Trail and for synchronous control patients with tracheostomy who received routine tracheostomy care. Patients on the Trach Trail and controls had similar demographic characteristics, diagnoses, and indications for tracheostomy. In the Trach Trail group, intensive care unit length of stay was significantly reduced as compared with the control group, decreasing from a mean 21 days to 10 ( P < .05). The incidence of adverse events was unchanged. Discussion Introduction of the Trach Trail was associated with a reduction in length of stay in the intensive care unit. Realizing broader patient-centered improvement likely requires engaging respiratory therapists, speech language pathologists, and social workers to maximize patient/caregiver engagement. Implications for Practice Standardized tracheostomy care with interdisciplinary collaboration may reduce length of stay and improve patient outcomes.

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

“…26,27 Patient involvement in interprofessional education may be beneficial in fostering person-centeredness, particularly in undergraduate students. 28,29 The importance of interprofessional education in health professions training is increasingly recognized through new accreditation guidelines, 30 and is being implemented in medical curricula as an effective learning method. 31 A recent systematic review highlighted positive results in students' attitudes towards learning and interprofessional collaboration; but highlighted concerns related to difficulties of implementation.…”

Nursing interventions for the promotion of tracheostomy self‐care: A scoping review

“…Assessing health status (background, including respiratory and nutritional status) (11,12,23) Face to face ( 5) Individual (5) 1-2 weeks before surgery (23) Different date from diagnosis (23) Assessing educational level (11) Assessing cognition (intellectual ability) (12,23) Assessing capabilities (manual dexterity, motor coordination, vision, hearing) (4,23) Assessing substance abuse (alcohol, tobacco, among others) (20,22,23) Assessing social and financial status and work context (5,11,12,20,22) Assessing psychological and emotional status (acceptance/attitude, reaction to surgery, anxiety) (5,11,20,22,23,31) Assessing housing conditions (11,12) Assessing family and social support (5,12,20,22) Assessing community service/resources (12) Assessing readiness to learn about tracheostomy care (2,9,12,24) Assessing knowledge about surgery and tracheostomy (4,5,12,16,23,24) Identifying expectations, establishing priorities, and negotiating the teaching plan (5,…”

“…Articles published between 1974 and 2020 have been included, with the majority from the USA and England. Concerning the study design, several works were included: 8 quality improvement project designs (Buiret et al, 2019;Cherney et al, 2020;Chunyi, 2014;Coutinho, 2012;Feber, 1998;Ge et al, 2014;Spito & Cavaliere, 2019;Winget, 1987), 10 opinion articles (based on non-systematic reviews of the literature and the individual experience of the authors as experts) (Bowers & Scase, 2007;Feinstein, 1987;Haynes, 1996;Lewarski, 2005;Mason et al, 1992;Nicouleau & Cotto, 2015;Patry-Lahey, 1985;Roland, 2013;Scase, 2004;Serra, 2000), 5 case studies (Behrens & Wiley, 1974;Chu, 1985;De Juan Pardo, 2000;Landis et al, 2011;Pagana, 1978), 3 literature reviews (Cady, 2002;Lopes da Costa et al, 2019;Mitchell et al, 2013), 2 qualitative studies (Morris et al, 2020;Oliveira, 2009), 1 quasi-experimental two-group randomised controlled trial (Valiee et al, 2016) and 2 single group pilot studies (Cnossen et al, 2016;Graboyes et al, 2017). However, many of the included studies did not describe in detail the research method used.…”

“…Involving family (2,6,20,21,23) Selecting a caregiver to follow the entire clinical circuit (2,6) At the preoperative admission (2) Involving the caregiver and family in the care plan (2,20,21) Encouraging the family to support the person (20) Referring to interprofessional team (12,20,21,23,24) Guiding for a social worker, psychologist, nutritionist, speech therapist, smoking/ alcohol cessation consultation, if indicated (12,20,21) Note: To facilitate reading of the results, the authors' references are numbered 1-31. The correspondence between the numbering and the respective author/article can be found in the references section.…”

Mitigating Tracheostomy‐Related Latent Safety Threats Through In Situ Simulation: Catch Them Before They Fall

“…This tactic differs from morbidity and mortality conference, root cause analyses, or incident reporting systems that necessitate an untoward outcome to catalyze improvements. 3,4 In situ simulation parallels failure mode and effects analysis—a process of reviewing system components to preemptively identify potential failure modes. 5 Although used in the automotive industry since the 1970s, forward-looking approaches are uncommon in health care.…”