Tracheostomy Care Education for the Nonsurgical First Responder: A Needs‐Based Assessment and Quality Improvement Initiative

Abstract

Objectives To perform a needs-based assessment for tracheostomy care education for nonsurgical first responders in the hospital setting and to implement and assess the efficacy of a targeted tracheostomy educational program. Methods A prospective observational study conducted between October 2017 and May 2018 including emergency medicine (EM) residents, internal medicine (IM) residents, and intensive care unit (ICU) advanced practice providers at 2 tertiary hospitals. Needs-based assessments were conducted, leading to specialty specific curricula. One-hour educational sessions included didactics and case-based simulation. A pre- and posttest objective knowledge quiz and self-assessment were administered, and a posttest was repeated at 6 months. Results There were 85 participants (13 ICU, 40 EM, 32 IM). Significant improvement ( P < .05) in mean objective knowledge score was seen across all groups between pre- and postintervention assessments with relative but not significant improvement at 6 months. There were significant increases in comfort level from pre- to postintervention. At 6-month follow-up, comfort level remained significantly increased for the majority of questions for the EM group and for select questions for IM and ICU advanced practice provider groups. Discussion Nonsurgeons are often first responders to critical airway situations yet receive limited formal education regarding tracheostomy. We demonstrated improvement in knowledge and comfort after a targeted educational module for tracheostomy care and management. Implications for Practice Although tracheostomy care is multidisciplinary, specialty-specific education may provide a more relevant foundation on which to build skills. Prompt and effective management of tracheostomy emergencies by first responders may improve patient safety and reduce mortality.

Tracheotomy care simulation training program for inpatient providers

“…Learners were evaluated using pre‐training and post‐training surveys that included a multiple‐choice knowledge test and self‐perceived comfort level ratings, which are evaluation methods consistent with other tracheotomy education programs in the literature. 6 , 12 , 13 , 14 , 18 …”

“…Learners were evaluated using pre-training and posttraining surveys that included a multiple-choice knowledge test and self-perceived comfort level ratings, which are evaluation methods consistent with other tracheotomy education programs in the literature. 6,[12][13][14]18 Immediately before watching the online module, trainees completed a pre-training survey (Appendix S1), in which participants rated their comfort with 9 tracheotomy care activities and were tested on facts relevant to tracheotomy care through 10 questions written by the authors.…”

“… 9 , 10 , 11 Better results have been demonstrated with instructor‐guided simulation, including programs on tracheotomy care education. 12 , 13 , 14 , 15 , 16 , 17 , 18 However, because instructor‐led simulation is time intensive and incorporating high‐fidelity mannequins can be costly, generalized use of these modalities is limited. This, coupled with the relative infrequency of airway complications, may contribute to the fact that knowledge, competence, and confidence with urgent and emergent airway and tracheotomy scenarios among non‐otolaryngology providers remains poor.…”

“…However, lecture‐style learning and review of written material in isolation can carry the limitation of reduced learner engagement and retention 9–11 . Better results have been demonstrated with instructor‐guided simulation, including programs on tracheotomy care education 12–18 . However, because instructor‐led simulation is time intensive and incorporating high‐fidelity mannequins can be costly, generalized use of these modalities is limited.…”

Efficacy of standardized tracheostomy training with a simulation model for healthcare providers: A study by ISPAT team

“…There are studies showing the efficacy of training given to health professionals by using different training methods regarding tracheostomy care. 20,21 Hence, the incorporation of a simulation model into the practical education program can be effective in improving the knowledge, confidence, and skills of HCP. 19,22,23 The aim of this study was to evaluate the efficacy of a training program with a simulation model for HCP who manage patients with tracheostomy in a multicenter setting.…”