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Schiff E, Propst EJ, Balakrishnan K, Johnson K, Lounsbury DW, Brenner MJ, Tawfik MM, Yang CJ. Pediatric Tracheostomy Emergency Readiness Assessment Tool: International Consensus Recommendations. Laryngoscope 2023; 133:3588-3601. [PMID: 37114735 PMCID: PMC10710770 DOI: 10.1002/lary.30674] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/17/2023] [Accepted: 03/07/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To achieve consensus on critical steps and create an assessment tool for actual and simulated pediatric tracheostomy emergencies that incorporates human and systems factors along with tracheostomy-specific steps. METHODS A modified Delphi method was used. Using REDCap software, an instrument comprising 29 potential items was circulated to 171 tracheostomy and simulation experts. Consensus criteria were determined a priori with a goal of consolidating and ordering 15 to 25 final items. In the first round, items were rated as "keep" or "remove". In the second and third rounds, experts were asked to rate the importance of each item on a 9-point Likert scale. Items were refined in subsequent iterations based on analysis of results and respondents' comments. RESULTS The response rates were 125/171 (73.1%) for the first round, 111/125 (88.8%) for the second round, and 109/125 (87.2%) for the third round. 133 comments were incorporated. Consensus (>60% participants scoring ≥8, or mean score >7.5) was reached on 22 items distributed across three domains. There were 12, 4, and 6 items in the domains of tracheostomy-specific steps, team and personnel factors, and equipment respectively. CONCLUSIONS The resultant assessment tool can be used to assess both tracheostomy-specific steps as well as systems factors affecting hospital team response to simulated and clinical pediatric tracheostomy emergencies. The tool can also be used to guide debriefing discussions of both simulated and clinical emergencies, and to spur quality improvement initiatives. LEVEL OF EVIDENCE 5 Laryngoscope, 133:3588-3601, 2023.
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Affiliation(s)
- Elliot Schiff
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Evan J Propst
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Karthik Balakrishnan
- Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California, USA
| | - Kaalan Johnson
- Department of Otolaryngology - Head and Neck Surgery, University of Washington/ Division of Pediatric Otolaryngology - Head and Neck Surgery, Seattle Children's Hospital, Seattle, WA, USA
| | - David W Lounsbury
- Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Christina J Yang
- Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, USA
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Richardson J, Girardot K, Powers J, Kadenko-Monirian M. Clinical Nurse Specialist Tracheostomy Management Improves Patient Outcomes. J Nurs Care Qual 2023; 38:251-255. [PMID: 36652765 DOI: 10.1097/ncq.0000000000000691] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Patients with a tracheostomy are a low-volume, high-risk population with long lengths of hospital stay and high health care costs. PROBLEM Because of the complex nature of caring for patients with a tracheostomy, it is essential to provide a standardized care approach with ongoing monitoring to optimize outcomes. APPROACH A pre/postimplementation design was used. A formal tracheostomy care management process using clinical nurse specialists (CNSs) was implemented. OUTCOMES Between April 2019 and December 2020, this process resulted in a significant reduction in time between tracheostomy placement and discharge, from 16 to 12.9 days ( P = .02). Reductions were also seen in length of stay and incidence of tracheostomy-related pressure injuries. CONCLUSIONS This project shows that a CNS-led care management process can improve patient outcomes. These improvements in patient outcomes resulted in a significant cost savings to the organization.
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Jamaldeen J, Nalamate R, Kurien M, Basheer A, Rose. Otolaryngologists' Initiative for Collaborative Tracheostomy Care: Knowledge, Attitude and Skill in Tracheostomy Care Among Nurses - An Interventional Study from India. Indian J Otolaryngol Head Neck Surg 2023; 75:1-7. [PMID: 37362136 PMCID: PMC10163569 DOI: 10.1007/s12070-023-03682-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/03/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction: Tracheostomy-related adverse events are a global problem, requiring coordinated approach for care of tracheostomised patients. The concept of 'collaborative tracheostomy care' was introduced by Global Tracheostomy Collaborative in 2012. For successful post tracheostomy outcome, nursing care is vital. Data on their knowledge, attitude and skills regarding tracheostomy care including outcome of a structured interventional workshop is not available from India. Methods: A validated questionnaire with items pertaining to knowledge, attitude and skills regarding tracheostomy care was administered to nurses working in intensive care units and wards. Following this, a workshop was conducted for hands-on training in tracheostomy care using didactic lectures, videos and simulation-based training. The participants took a post-test immediately and after three months. Skills were assessed before and three months after the workshop using a checklist. Results: Among 386 participants who attended the pre-test and workshop, 285 (74.2%) underwent post-test immediately and three months later. Overall mean knowledge score (± SD) of the participants in pre-workshop was 6.8 ± 3.5, immediate post-test score was 15.9 ± 2.7 and three months later was 11.6 ± 3.5 (p < 0.001) out of total score 20. The baseline score was significantly higher among ICU nurses. Three months post workshop skill assessment revealed no statistically significant increase in the proportion of participants who performed skills related to suctioning procedure. Conclusion: Knowledge, attitude and practice regarding tracheostomy care is inadequate among nurses. Otolaryngologists-driven structured intervention with didactic lectures, videos and hands-on training can improve all three domains to positively impact outcomes in post tracheostomy patient care. Supplementary Information The online version contains supplementary material available at 10.1007/s12070-023-03682-9.
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Affiliation(s)
- Jishana Jamaldeen
- Department of ENT, Dr Moopen’s Medical College, Wayanad, 673577 Kerala India
| | | | - Mary Kurien
- Department of ENT, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Aneesh Basheer
- Department of General Medicine, Dr Moopen’s Medical College, Wayanad, India
| | - Rose
- College of Nursing, Pondicherry Institute of Medical Sciences, Puducherry, India
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Mahfoz TMB. Attitude and practices of tracheostomy care among nursing staff in Saudi Arabia. BMC Nurs 2022; 21:367. [PMID: 36550512 PMCID: PMC9780093 DOI: 10.1186/s12912-022-01150-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In many regions of the world, tracheostomy care is a major health concern. Many patients die as a result of nurses' lack of awareness regarding tracheostomy care. This study was carried out to report the acquired training, clinical experience and team approach while caring for patients with tracheostomies and then evaluate these aspects on nurses' confidence in caring for these patients. METHODS A cross-sectional descriptive study involving a self-administered questionnaire was carried out among nurses from October 2020 to June 2021. A self-administered questionnaire including questions on sociodemographic characteristics, tracheostomy training and support and confidence in caring for patients with tracheostomies. It was disseminated electronically to the nurses working in a tertiary medical center in Saudi Arabia with multiple reminders. Group difference was determined using t test and chi square tests appropriately with a set p value to less than 0.05. RESULTS A total of 315 nurses with different educational backgrounds were included. The majority were females, middle aged and gained their nursing degree from outside the country. Over 30% of the nurses cared for patients with tracheostomies while more than two thirds did not receive adequate training to care for this patient population. Confidence was reflected in the working units, the time spent caring for these patients and the number of patients cared for. Additionally, nurses caring for children and adults with tracheostomies were more confident in their care than those caring for adolescents and older adults. CONCLUSION Continuous training and competency evaluation are vital in delivering optimal care. Confidence level is impacted by training received and by the presence of assisted ventilation. Future studies should aim for a national representation of this topic to inform policy and practice.
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Affiliation(s)
- Turki M. Bin Mahfoz
- grid.440750.20000 0001 2243 1790Department of Otolaryngology, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, 13317 Saudi Arabia
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Alotaibi FZ, Alkhatabi R, Allowaihiq L, Alhazzani H, Alshehri G, Hajr EA, Alkholaiwi F. Assessment of the ability, perception, and readiness of nurses to manage tracheostomy-related complications in Riyadh City: a cross-sectional study. BMC Nurs 2022; 21:320. [PMID: 36419082 PMCID: PMC9682812 DOI: 10.1186/s12912-022-01101-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/10/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Nursing staff play a key role in the bedside management of tracheostomized patients in both intensive care units and general floors. Effective provision of postoperative care to these patients by nurses is critical. This study aimed to assess the readiness of nursing staff to manage tracheostomy-related complications in Riyadh, Saudi Arabia. METHODS This cross-sectional study enrolled 395 nurses in Riyadh, Saudi Arabia. A self-administered questionnaire developed by the authors was distributed to nurses via an online survey. The questionnaire assessed nurses' socio-demographic characteristics and their knowledge and practices regarding tracheostomy indications, postoperative care, and management of its complications. RESULTS Of respondents, approximately 59% (232/395) had poor knowledge regarding tracheostomy-related complications and indications, 39% (154/395) had moderate knowledge, and only 2%(9/395) had good knowledge. Several factors were associated with increased knowledge, including having a higher education degree, working in a tertiary/quaternary hospital, being a government employee, caring for tracheostomized patients, and attending courses or lectures on managing tracheostomized patients. CONCLUSIONS Knowledge level and practices regarding tracheostomy-related complications and indications among nurses remain limited. In-service continuous professional development programs for nurses working in all hospital settings are strongly recommended. Further research is warranted to elicit the major factors contributing to inadequate knowledge and practices among nurses in Riyadh.
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Affiliation(s)
- Fahad Zarraq Alotaibi
- College of Medicine, Imam Mohammed Ibn Saud Islamic University, Othman Bin Affan Road Alnada-7544, 13317-4233 Riyadh, Kingdom of Saudi Arabia ,grid.440750.20000 0001 2243 1790Department of Otorhinolaryngology-Head and Neck Surgery, Imam Mohammad Ibn Saud Islamic University, Othman Bin Affan Road Alnada-7544, 13317-4233 Riyadh, Kingdom of Saudi Arabia
| | - Reema Alkhatabi
- College of Medicine, Imam Mohammed Ibn Saud Islamic University, Othman Bin Affan Road Alnada-7544, 13317-4233 Riyadh, Kingdom of Saudi Arabia
| | - Lujain Allowaihiq
- College of Medicine, Imam Mohammed Ibn Saud Islamic University, Othman Bin Affan Road Alnada-7544, 13317-4233 Riyadh, Kingdom of Saudi Arabia
| | - Hassan Alhazzani
- grid.56302.320000 0004 1773 5396College of Medicine, King Saud University, King Khalid Road 11451, Riyadh, 2454-1145 Saudi Arabia
| | - Ghada Alshehri
- College of Medicine, Imam Mohammed Ibn Saud Islamic University, Othman Bin Affan Road Alnada-7544, 13317-4233 Riyadh, Kingdom of Saudi Arabia
| | - Eman A. Hajr
- College of Medicine, Imam Mohammed Ibn Saud Islamic University, Othman Bin Affan Road Alnada-7544, 13317-4233 Riyadh, Kingdom of Saudi Arabia ,grid.440750.20000 0001 2243 1790Department of Otorhinolaryngology-Head and Neck Surgery, Imam Mohammad Ibn Saud Islamic University, Othman Bin Affan Road Alnada-7544, 13317-4233 Riyadh, Kingdom of Saudi Arabia
| | - Feras Alkholaiwi
- College of Medicine, Imam Mohammed Ibn Saud Islamic University, Othman Bin Affan Road Alnada-7544, 13317-4233 Riyadh, Kingdom of Saudi Arabia ,grid.440750.20000 0001 2243 1790Department of Otorhinolaryngology-Head and Neck Surgery, Imam Mohammad Ibn Saud Islamic University, Othman Bin Affan Road Alnada-7544, 13317-4233 Riyadh, Kingdom of Saudi Arabia
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Unidad de Atención al Paciente Traqueostomizado. Una solución innovadora desde Otorrinolaringología con carácter transversal para el hospital. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022. [DOI: 10.1016/j.otorri.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Zhang B, Chen C. Comparison of Ventilator-Associated Pneumonia and Surgical Site Infection between Two Methods of Tracheostomy. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:3186634. [PMID: 35872939 PMCID: PMC9307366 DOI: 10.1155/2022/3186634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/21/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022]
Abstract
Objective To compare the incidence of ventilator-associated pneumonia (VAP) and surgical site infection (SSI) between percutaneous dilatational tracheostomy (PDT) and surgical tracheostomy (ST). Methods Data on 487 patients undergoing tracheostomy between 1st January 2014 and 30th September 2020 were reviewed. Patients were divided according to the surgical techniques. Clinical characteristics and postoperative care were compared to explore the risk factors for SSI and VAP. All tracheostomies were performed by intensivists who had completed at least ten tracheostomies. ST was performed using standard techniques. PDT was performed according to a modification technique described by Ciaglia. All procedures were performed at the bedside in the ICU. Results Of all, 344 patients (70.6%) were men and 143 (29.4%) were women, and the mean age was 56 years (standard derivation [SD] 12 years). Two hundred and sixty-six patients (54.6%) received PDT, and 221 (45.4%) received SY. Patients in the PDT group had a significantly lower rate of SSI (3.4% vs. 8.5%, P = 0.01) compared with the ST group. Multivariate analysis revealed that comorbidities (P = 0.003), surgical type (P = 0.01), and cluster nursing (P < 0.001) were independent risk factors for SSI; age (P = 0.005), comorbidities (P < 0.001), smoking (P = 0.008), and cluster nursing (P = 0.01) were independent risk factors for VAP. Conclusion PDT significantly reduces the risk of SSI. Proper care should be administrated in patients with one or more risk factors of SSI or VAP to prevent the occurrence of complications.
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Affiliation(s)
- Baozhi Zhang
- The Nursing Department, The Second Affiliated Hospital of Guangdong Medical University, China
| | - Chunyan Chen
- Department of Critical Care Medicine, The Second Affiliated Hospital of Guangdong Medical University, China
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Chopra P, Sodhi K, Shrivastava A, Tandon S, Joia RK. Impact of early versus late tracheostomy on patient outcomes in a tertiary care multispeciality ICU. J Anaesthesiol Clin Pharmacol 2021; 37:458-463. [PMID: 34759562 PMCID: PMC8562452 DOI: 10.4103/joacp.joacp_229_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 07/09/2019] [Accepted: 09/13/2019] [Indexed: 11/29/2022] Open
Abstract
Background and Aims: Tracheostomy is a commonly performed procedure in critically ill patients because patients requiring chronic mechanical ventilation (MV) are rising by as much as 5.5% per year. The controversy on likely benefits of early versus late tracheostomy is ongoing. We aimed to study the impact of early versus late tracheostomy on patient outcomes. Material and Methods: A retrospective observational study was performed in intensive care unit (ICU) patients who underwent tracheostomy in a 31-bedded multispeciality ICU of a 350-bedded tertiary care hospital, over a period of 1 year. Data collected included the age, sex, APACHE II score, indication for tracheostomy, timing of procedure, whether surgical or percutaneous, any complication, MV days, ICU stay, and patient outcome. Patients were divided into two groups for statistical comparison: early ≤7 days and late >7 days of MV. Results: A total of 102 patients underwent tracheostomy over the study period, of which 19 were excluded because of inadequate data and exclusion criteria. Of the 83 study patients, 60 had percutaneous, while 23 had surgical tracheostomy. About 51 (61.45%) had early, while 32 (38.55%) had late tracheostomy. On statistical analysis, there was a significant difference in MV days (5 vs 12.5 days, P = 0.002), ICU stay (10 vs 16 days, P = 0.004), mortality (21.6% vs 43.8%, P = 0.032), and decannulation rate (29.41% vs 6.25%, P = 0.009). No difference was observed in hospital stay or complication rates. Conclusion: Early tracheostomy is associated with both morbidity and mortality benefits. Patients requiring MV should be given an option of early tracheostomy.
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Affiliation(s)
- Puneet Chopra
- Department of Critical Care, SPS Hospitals, Ludhiana, Punjab, India
| | | | | | - Shivani Tandon
- Department of Quality and Clinical Pharmacology, SPS Hospitals, Ludhiana, Punjab, India
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Ahmed ST, Yang C, Deng J, Bottalico DM, Matta-Arroyo E, Cassel-Choudhury G, Yang CJ. Implementation of an Online Multimedia Pediatric Tracheostomy Care Module for Healthcare Providers. Laryngoscope 2021; 131:1893-1901. [PMID: 33459406 DOI: 10.1002/lary.29400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 12/10/2020] [Accepted: 01/04/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the effect of a multimedia educational module on provider attitudes toward pediatric tracheostomy care. We also describe the process of module development and dissemination at an academic children's hospital. STUDY DESIGN Prospective observational study. METHODS The pediatric airway committee at an urban tertiary care center developed a multimedia pediatric tracheostomy care module. Nurses, respiratory therapists, as well as resident, fellow, and attending physicians caring for pediatric patients with tracheostomies were eligible. Managers and clinical supervisors from various units recruited participants to complete the pediatric tracheostomy care electronic module and pre- and postassessment knowledge quizzes and surveys. Provider confidence was analyzed using Kruskal-Wallis H-test and Mann-Whitney U-test, and paired t-test was used to compare pre- and postmodule quiz scores. RESULTS A total of 422 participants completed the module. A total of 275 participants completed the premodule survey, 385 completed the premodule quiz, 253 completed the postmodule survey, and 233 completed the postmodule quiz. Participants included providers in the neonatal intensive care unit, pediatric intensive care unit, pediatric emergency department, and pediatric wards. Postmodule surveys demonstrated a significant reduction in the average percentage of participants indicating lack of confidence with regards to changing an established tracheostomy, responding to accidental decannulation of established tracheostomy, and responding to accidental decannulation of fresh tracheostomy (P < .001). Average quiz scores increased by 5.6 points from 83.0% to 88.6% (P < .00001). CONCLUSIONS A multimedia educational module can improve provider perception of their knowledge and confidence surrounding pediatric tracheostomy management. LEVEL OF EVIDENCE 3 Laryngoscope, 131:1893-1901, 2021.
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Affiliation(s)
- Sadia T Ahmed
- Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - Catherina Yang
- Department of Otorhinolaryngology, Montefiore Medical Center, Bronx, New York, U.S.A
| | - Junwen Deng
- Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - Danielle M Bottalico
- Department of Otorhinolaryngology, Montefiore Medical Center, Bronx, New York, U.S.A
| | - Esther Matta-Arroyo
- Division of Respiratory and Sleep Medicine, Children's Hospital at Montefiore, Bronx, New York, U.S.A
| | - Gina Cassel-Choudhury
- Albert Einstein College of Medicine, Bronx, New York, U.S.A.,Division of Pediatric Critical Care Medicine, Children's Hospital at Montefiore, Bronx, New York, U.S.A
| | - Christina J Yang
- Albert Einstein College of Medicine, Bronx, New York, U.S.A.,Department of Otorhinolaryngology, Montefiore Medical Center, Bronx, New York, U.S.A
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Keagaetsho G, Downing C. What happens when registered nurses are caring for patients with tracheostomies in the ward of a referral hospital in Botswana? INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2020.100277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Gaterega T, Mwiseneza MJ, Chironda G. Nurses knowledge and practices regarding tracheostomy care at a selected referral hospital in Rwanda – A descriptive cross-sectional study. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2021. [DOI: 10.1016/j.ijans.2021.100350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Mehta K, Mosha MH, Kavanagh KR. A targeted tracheostomy care educational initiative to augment resuscitation training in the pediatric setting. Int J Pediatr Otorhinolaryngol 2020; 133:109944. [PMID: 32087480 DOI: 10.1016/j.ijporl.2020.109944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 02/10/2020] [Accepted: 02/10/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To implement a surgeon led initiative for tracheostomy education for non-surgical pediatric first responders in the hospital setting and to assess its efficacy. METHODS A prospective, observational study conducted from September 2018 to March 2019. All pediatric residents at a tertiary care children's hospital were invited to participate. An objective knowledge test and self-assessment comfort questionnaire was completed before and after the intervention and at 6-month follow up. Educational sessions involved a targeted, interactive program with a didactic presentation and case-based simulation. RESULTS Forty-four pediatric residents participated. Residents had limited experience with tracheostomy intervention with only one reporting personally resolving a tracheostomy issue. However, tracheostomy complications were relatively common with 43% reporting having watched another specialty intervene on a tracheostomy issue during an airway related emergency. The objective knowledge test results significantly increased; from pre-knowledge test percent mean of 61.25 (SD = 13.52) to post-knowledge test percent mean of 81.25 (SD = 10.57) [t(39) = -8.144, p < 0.001]. Comfort levels questionnaire median (IQR) results were also significantly higher than pre-intervention [3.70 (3.20-3.88) vs. 2.65 (2.13-3.00), Z = 780, p < .001]. CONCLUSION We demonstrated improved knowledge among pediatric residents after a surgeon-led module for tracheostomy care and emergency management. A targeted tracheostomy education program may fill a gap in pediatric resident emergency resuscitation education.
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Affiliation(s)
- Kinneri Mehta
- Division of Otolaryngology-Head and Neck Surgery, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030, USA.
| | - Maua H Mosha
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA
| | - Katherine R Kavanagh
- Division of Otolaryngology-Head and Neck Surgery, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030, USA; Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, USA
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Sioshansi PC, Balakrishnan K, Messner A, Sidell D. Pediatric tracheostomy practice patterns. Int J Pediatr Otorhinolaryngol 2020; 133:109982. [PMID: 32171147 DOI: 10.1016/j.ijporl.2020.109982] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 02/02/2020] [Accepted: 03/01/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Despite recent guidelines and the frequency of pediatric tracheostomy, surgical techniques and perioperative management are variable. We aim to describe the post-operative practice patterns following tracheostomy in children. METHODS An electronic cross-sectional survey was distributed to American Society of Pediatric Otolaryngologists (ASPO) members in academic and private practice settings. Responses were collected anonymously and analyzed by percentages of respondents who employ specific management strategies. Statistical analysis of response distributions performed using the Z test of proportions for binary questions and the Mantel-Haenszel chi-square test for questions with more than two options. For questions with ordered categorical responses, Cuzick's nonparametric test of trend was used. RESULTS One-hundred twenty-four responses were received (22.3%). Most respondents were fellowship trained and practiced in academic medical centers. A greater number of tracheostomies were performed by respondents practicing in the Midwest region (p = 0.042). There was no variability in the number of tracheostomies performed based on practitioner age, hospital setting, or fellowship training. The majority perform stoma maturation and/or stay suture techniques intraoperatively and send patients to the intensive care unit postoperatively. The routine use of postoperative paralysis was reported by a minority of respondents and 50% reported the use of sedation. There was a roughly-even distribution of respondents who reported postoperative immobilization, mobilization to a chair, and ambulation respectively. Routine; postoperative airway evaluations were reported by 35% of respondents. Clinic follow-up was; variable. CONCLUSION These results demonstrate ongoing variability in the postoperative management strategies following tracheostomy in children and highlight areas for further study.
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Affiliation(s)
- Pedrom C Sioshansi
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Karthik Balakrishnan
- Department of Otorhinolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Anna Messner
- Department of Otolaryngology/Head & Neck Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Douglas Sidell
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA; Pediatric Aerodigestive and Airway Reconstruction Center, Lucile Packard Children's Hospital, Stanford, Stanford, CA, USA.
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Cherney RL, Pandian V, Ninan A, Eastman D, Barnes B, King E, Miller B, Judkins S, Smith AE, Smith NM, Hanley J, Creutz E, Carlson M, Schneider KJ, Shever LL, Casper KA, Davidson PM, Brenner MJ. The Trach Trail: A Systems-Based Pathway to Improve Quality of Tracheostomy Care and Interdisciplinary Collaboration. Otolaryngol Head Neck Surg 2020; 163:232-243. [PMID: 32450771 DOI: 10.1177/0194599820917427] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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.
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Affiliation(s)
- Rebecca L Cherney
- University of Michigan Hospital and Health Center, Ann Arbor, Michigan, USA.,University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | | | - Ashly Ninan
- University of Michigan Hospital and Health Center, Ann Arbor, Michigan, USA.,Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Debra Eastman
- University of Michigan Hospital and Health Center, Ann Arbor, Michigan, USA
| | - Brian Barnes
- University of Michigan Hospital and Health Center, Ann Arbor, Michigan, USA
| | - Elizabeth King
- University of Michigan Hospital and Health Center, Ann Arbor, Michigan, USA
| | - Brianne Miller
- University of Michigan Hospital and Health Center, Ann Arbor, Michigan, USA
| | - Samantha Judkins
- University of Michigan Hospital and Health Center, Ann Arbor, Michigan, USA
| | - Alfred E Smith
- Global Tracheostomy Quality Improvement Collaborative, Raleigh, North Carolina, USA
| | - Nan M Smith
- Global Tracheostomy Quality Improvement Collaborative, Raleigh, North Carolina, USA
| | - Julie Hanley
- University of Michigan Hospital and Health Center, Ann Arbor, Michigan, USA
| | - Eileen Creutz
- University of Michigan Hospital and Health Center, Ann Arbor, Michigan, USA
| | - Megan Carlson
- University of Michigan Hospital and Health Center, Ann Arbor, Michigan, USA
| | - Kevin J Schneider
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | - Leah L Shever
- University of Michigan Hospital and Health Center, Ann Arbor, Michigan, USA.,University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, Ann Arbor, Michigan, USA
| | | | - Michael J Brenner
- Global Tracheostomy Quality Improvement Collaborative, Raleigh, North Carolina, USA.,Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical Center, Ann Arbor, Michigan, USA
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15
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Mehta K, Schwartz M, Falcone TE, Kavanagh KR. Tracheostomy Care Education for the Nonsurgical First Responder: A Needs-Based Assessment and Quality Improvement Initiative. OTO Open 2019; 3:2473974X19844993. [PMID: 31428724 PMCID: PMC6684148 DOI: 10.1177/2473974x19844993] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/22/2019] [Accepted: 03/29/2019] [Indexed: 11/16/2022] Open
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.
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Affiliation(s)
- Kinneri Mehta
- Division of Otolaryngology-Head and Neck Surgery, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Marissa Schwartz
- Division of Otolaryngology-Head and Neck Surgery, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Todd E Falcone
- Division of Otolaryngology-Head and Neck Surgery, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Katherine R Kavanagh
- Division of Otolaryngology-Head and Neck Surgery, University of Connecticut School of Medicine, Farmington, Connecticut, USA.,Connecticut Children's Medical Center, Hartford, Connecticut, USA
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16
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Bonvento B, Wallace S, Lynch J, Coe B, McGrath BA. Role of the multidisciplinary team in the care of the tracheostomy patient. J Multidiscip Healthc 2017; 10:391-398. [PMID: 29066907 PMCID: PMC5644554 DOI: 10.2147/jmdh.s118419] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Tracheostomies are used to provide artificial airways for increasingly complex patients for a variety of indications. Patients and their families are dependent on knowledgeable multidisciplinary staff, including medical, nursing, respiratory physiotherapy and speech and language therapy staff, dieticians and psychologists, from a wide range of specialty backgrounds. There is increasing evidence that coordinated tracheostomy multidisciplinary teams can influence the safety and quality of care for patients and their families. This article reviews the roles of these team members and highlights the potential for improvements in care.
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Affiliation(s)
- Barbara Bonvento
- Acute Intensive Care Unit, University Hospital South Manchester, Manchester
| | - Sarah Wallace
- Acute Intensive Care Unit, University Hospital South Manchester, Manchester.,Royal College of Speech and Language Therapists, London, UK
| | - James Lynch
- Acute Intensive Care Unit, University Hospital South Manchester, Manchester
| | - Barry Coe
- Acute Intensive Care Unit, University Hospital South Manchester, Manchester
| | - Brendan A McGrath
- Acute Intensive Care Unit, University Hospital South Manchester, Manchester
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17
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CASASOLA-GIRÓN M, BENITO-OREJAS JI, BOBILLO-DE LAMO F, PARRA-MORAIS L, CICUÉNDEZ-ÁVILA R, MORAIS-PÉREZ D. Proyecto de seguridad del paciente traqueotomizado procedente de una unidad de cuidados críticos. REVISTA ORL 2017. [DOI: 10.14201/orl.16932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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18
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Spataro E, Durakovic N, Kallogjeri D, Nussenbaum B. Complications and 30-day hospital readmission rates of patients undergoing tracheostomy: A prospective analysis. Laryngoscope 2017; 127:2746-2753. [DOI: 10.1002/lary.26668] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/23/2017] [Accepted: 04/05/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Emily Spataro
- Department of Otolaryngology-Head and Neck Surgery; Washington University School of Medicine; St. Louis Missouri U.S.A
| | - Nedim Durakovic
- Department of Otolaryngology-Head and Neck Surgery; Washington University School of Medicine; St. Louis Missouri U.S.A
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery; Washington University School of Medicine; St. Louis Missouri U.S.A
| | - Brian Nussenbaum
- Department of Otolaryngology-Head and Neck Surgery; Washington University School of Medicine; St. Louis Missouri U.S.A
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19
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Yelverton JC, Nguyen JH, Wan W, Kenerson MC, Schuman TA. Effectiveness of a standardized education process for tracheostomy care. Laryngoscope 2014; 125:342-7. [DOI: 10.1002/lary.24821] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 06/10/2014] [Accepted: 06/13/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Joshua C. Yelverton
- Department of Otolaryngology-Head and Neck Surgery; Virginia Commonwealth University; Richmond Virginia U.S.A
| | - Josephine H. Nguyen
- Department of Otolaryngology-Head and Neck Surgery; Virginia Commonwealth University; Richmond Virginia U.S.A
| | - Wen Wan
- Department of Biostatistics; Virginia Commonwealth University; Richmond Virginia U.S.A
| | - Michael C. Kenerson
- Department of Otolaryngology-Head and Neck Surgery; Virginia Commonwealth University; Richmond Virginia U.S.A
| | - Theodore A. Schuman
- Department of Otolaryngology-Head and Neck Surgery; Virginia Commonwealth University; Richmond Virginia U.S.A
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