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Hassan B, Tawfik MM, Schiff E, Mosavian R, Kelly Z, Li D, Petti A, Bangar M, Schiff BA, Yang CJ. Harnessing In Situ Simulation to Identify Human Errors and Latent Safety Threats in Adult Tracheostomy Care. Jt Comm J Qual Patient Saf 2024; 50:279-284. [PMID: 38171951 PMCID: PMC10978288 DOI: 10.1016/j.jcjq.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Tracheostomies are associated with high rates of complications and preventable harm. Safe tracheostomy management requires highly functioning teams and systems, but health care providers are poorly equipped with tracheostomy knowledge and resources. In situ simulation has been used as a quality improvement tool to audit multidisciplinary team emergency response in the actual clinical environment where care is delivered but has been underexplored for tracheostomy care. METHODS From July 2021 to May 2022, the study team conducted in situ simulations of a tracheostomy emergency scenario at Montefiore Medical Center to identify human errors and latent safety threats (LSTs). Simulations included structured debriefs as well as audiovisual recording that allowed for blind rating of these human errors and LSTs. Provider knowledge deficits were further characterized using pre-simulation quizzes. RESULTS Twelve human errors and 15 LSTs were identified over 20 simulations with 88 participants overall. LSTs were divided into the following categories: communication, equipment, and infection control. Only 50.0% of teams successfully replaced the tracheostomy tube within the scenario's five-minute time limit. In addition, knowledge gaps were highly prevalent, with a median pre-simulation quiz score of 46% (interquartile range 36-64) among participants. CONCLUSION An in situ simulation-based quality improvement approach shed light on human errors and LSTs associated with tracheostomy care across multiple settings in one health system. This method of engaging frontline health care provider key stakeholders will inform the development, adaptation, and implementation of interventions.
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Bas Ikizoglu N, Atag E, Ergenekon P, Gokdemir Y, Uyan ZS, Girit S, Kilinc Sakalli AA, Erdem Eralp E, Cakir E, Guven F, Aksoy ME, Karadag B, Karakoc F, Oktem S. Implementation of a high fidelity simulation based training program for physicians of children requiring long term invasive home ventilation: a study by ISPAT team. Front Pediatr 2024; 12:1325582. [PMID: 38362002 PMCID: PMC10867101 DOI: 10.3389/fped.2024.1325582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 01/22/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction The number of children requiring long-term invasive home ventilation (LTIHV) has increased worldwide in recent decades. The training of physicians caring for these children is crucial since they are at high risk for complications and adverse events. This study aimed to assess the efficacy of a comprehensive high-fidelity simulation-based training program for physicians caring for children on LTIHV. Methods A multimodal training program for tracheostomy and ventilator management was prepared by ISPAT (IStanbul PAediatric Tracheostomy) team. Participants were subjected to theoretical and practical pre-tests which evaluated their knowledge levels and skills for care, follow-up, and treatment of children on LTIHV. Following the theoretical education and hands-on training session with a simulation model, theoretical and practical post-tests were performed. Results Forty-three physicians from 7 tertiary pediatric clinics in Istanbul were enrolled in the training program. Seventy percent of them had never received standardized training programs about patients on home ventilation previously. The total number of correct answers from the participants significantly improved after the theoretical training (p < 0.001). The number of participants who performed the steps correctly also significantly increased following the hands-on training session (p < 0.001). All of the 43 participants who responded rated the course overall as good or excellent. Conclusion The knowledge and skills of clinicians caring for children on LTIHV can be enhanced through a comprehensive training program consisting of theoretical training combined with hands-on training in a simulation laboratory.
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Affiliation(s)
- Nilay Bas Ikizoglu
- Division of Pediatric Pulmonology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkiye
| | - Emine Atag
- Division of Pediatric Pulmonology, School of Medicine, Maltepe University, Istanbul, Turkiye
| | - Pinar Ergenekon
- Division of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul, Turkiye
| | - Yasemin Gokdemir
- Division of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul, Turkiye
| | - Zeynep Seda Uyan
- Division of Pediatric Pulmonology, School of Medicine, Koc University, Istanbul, Turkiye
| | - Saniye Girit
- Division of Pediatric Pulmonology, Faculty of Medicine, Medeniyet University, Istanbul, Turkiye
| | - Ayse Ayzit Kilinc Sakalli
- Division of Pediatric Pulmonology, Cerrahpasa Faculty of Medicine, Istanbul-Cerrahpasa University, Istanbul, Turkiye
| | - Ela Erdem Eralp
- Division of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul, Turkiye
| | - Erkan Cakir
- Division of Pediatric Pulmonology, Faculty of Medicine, Istinye University, Istanbul, Turkiye
| | - Feray Guven
- Center of Advanced Simulation and Education (CASE), Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkiye
| | - Mehmet Emin Aksoy
- Center of Advanced Simulation and Education (CASE), Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkiye
| | - Bulent Karadag
- Division of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul, Turkiye
| | - Fazilet Karakoc
- Division of Pediatric Pulmonology, School of Medicine, Marmara University, Istanbul, Turkiye
| | - Sedat Oktem
- Division of Pediatric Pulmonology, School of Medicine, Medipol University, Istanbul, Turkiye
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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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Duymaz YK, Bayram F, Şahin Ş, Erkmen B, Uzar T, Önder S, Şahin Yilmaz AA, Tekin AM, Bahşi İ. Effectiveness of Training: Airway Management of Tracheostomized Pediatric Patients by Pediatric Residents and Anesthesiology Residents. J Craniofac Surg 2023; 34:2518-2521. [PMID: 37603891 DOI: 10.1097/scs.0000000000009628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/03/2023] [Indexed: 08/23/2023] Open
Abstract
To evaluate the effect of training on increasing baseline knowledge of pediatrics and anesthesia residents about airway management of pediatric patients with tracheostomy. It is a prospective, descriptive, before and after survey study. A questionnaire was conducted to measure the baseline knowledge of pediatrics and anesthesia residents about airway management in patients with pediatric tracheotomy. The same questionnaire was repeated after the education. Of the 63 participants, 42 were pediatric residents and 21 were anesthesiology residents. While the number of participants who answered the cuff part, inner cannula part, obturator part and balloon part of the tracheostomy tube correctly before the training was 27, 4, 10, and 12, respectively, these numbers increased to 53, 52, 57, and 55 after the training. There was a statistically significant improvement after the training in the correct response of the cuff, inner cannula, obturator, and balloon sections. A statistically significant improvement was observed in the answers received after the training for all 7 questions regarding the clinical scenario of accidental decannulation and tracheostomy bleeding compared to the pre-training. There was a statistical improvement in part where the participants rated themselves. In conclusion, training increases the ability of healthcare professionals to cope with life-threatening complications related to pediatric tracheotomy. A standardized education program on pediatric tracheostomy should be included in the routine programs of associated departments such as emergency medicine, anesthesia, and pediatrics residencies.
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Affiliation(s)
- Yasar Kemal Duymaz
- Department of Otolaryngology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Furkan Bayram
- Department of Otolaryngology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | | | - Burak Erkmen
- Department of Otolaryngology, Sancaktepe Martyr Prof Dr Ilhan Varank Training and Research Hospital, University of Health Sciences, İstanbul, Turkey
| | - Tuğçe Uzar
- Department of Otolaryngology, Umraniye Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Serap Önder
- Acibadem Ataşehir Hospital, Istanbul, Turkey
| | - Ayse A Şahin Yilmaz
- Department of Otolaryngology, Lütfi Kirdar Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | - Ahmet M Tekin
- Department of Otolaryngology and Head & Neck Surgery, Vrije Universiteit Brussel, University Hospital UZ Brussel, Brussels Health Campus, Belgium
| | - İlhan Bahşi
- Department of Anatomy, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
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5
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Jung DTU, Grubb L, Moser CH, Nazarian JTM, Patel N, Seldon LE, Moore KA, McGrath BA, Brenner MJ, Pandian V. Implementation of an evidence-based accidental tracheostomy dislodgement bundle in a community hospital critical care unit. J Clin Nurs 2023; 32:4782-4794. [PMID: 36200145 PMCID: PMC9874912 DOI: 10.1111/jocn.16535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/13/2022] [Accepted: 08/23/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Tracheostomy dislodgment can lead to catastrophic neurological injury or death. A fresh tracheostomy amplifies the risk of such events, where an immature tract predisposes to false passage. Unfortunately, few resources exist to prepare healthcare professionals to manage this airway emergency. AIM To create and implement an accidental tracheostomy dislodgement (ATD) bundle to improve knowledge and comfort when responding to ATD. MATERIALS & METHODS A multidisciplinary team with expertise in tracheostomy developed a 3-part ATD bundle including (1) Tracheostomy Dislodgement Algorithm, (2) Head of Bed Tracheostomy Communication Tool and (3) Emergency Tracheostomy Kit. The team tested the bundle during the COVID-19 pandemic in a community hospital critical care unit with the engagement of nurses and Respiratory Care Practitioners. Baseline and post-implementation knowledge and comfort levels were measured using Dorton's Tracheotomy Education Self-Assessment Questionnaire, and adherence to protocol was assessed. Reporting follows the revised Standards for Quality Improvement Reporting Excellence (SQUIRE). RESULTS Twenty-four participants completed pre-test and post-test questionnaires. The median knowledge score on the Likert scale increased from 4.0 (IQR = 1.0) pre-test to 5.0 (IQR = 1.0) post-test. The median comfort level score increased from 38.0 (IQR = 7.0) pre-test to 40.0 (IQR = 5.0) post-test). In patient rooms, adherence was 100% for the Head of Bed Tracheostomy Communication Tool and Emergency Tracheostomy Kit. The adherence rate for using the Dislodgement Algorithm was 55% in ICU and 40% in SCU. DISCUSSION This study addresses the void of tracheostomy research conducted in local community hospitals. The improvement in knowledge and comfort in managing ATD is reassuring, given the knowledge gap among practitioners demonstrated in prior literature. The ATD bundle assessed in this study represents a streamlined approach for bedside clinicians - definitive management of ATD should adhere to comprehensive multidisciplinary guidelines. CONCLUSIONS ATD bundle implementation increased knowledge and comfort levels with managing ATD. Further studies must assess whether ATD bundles and other standardised approaches to airway emergencies reduce adverse events. Relevance to Clinical Practice A streamlined intervention bundle employed at the unit level can significantly improve knowledge and comfort in managing ATD, which may reduce morbidity and mortality in critically ill patients with tracheostomy.
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Affiliation(s)
- Dawn Ta Un Jung
- Division of Cardiac SurgeryJohns Hopkins HospitalBaltimoreMarylandUSA
| | - Lisa Grubb
- Johns Hopkins Medicine Howard County General HospitalColumbiaMarylandUSA
- Johns Hopkins School of NursingBaltimoreMarylandUSA
| | | | | | - Neesha Patel
- Johns Hopkins Medicine Howard County General HospitalColumbiaMarylandUSA
| | - Lisa E. Seldon
- Johns Hopkins Medicine Howard County General HospitalColumbiaMarylandUSA
| | - Kristin A. Moore
- Johns Hopkins Medicine Howard County General HospitalColumbiaMarylandUSA
| | - Brendan A. McGrath
- University of Manchester, NHS Foundation Trust, National Tracheostomy Safety ProjectManchesterUK
| | - Michael J. Brenner
- Department of Otolaryngology – Head & Neck SurgeryUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Global Tracheostomy CollaborativeRaleighNorth CarolinaUSA
| | - Vinciya Pandian
- Department of Nursing FacultyJohns Hopkins UniversityBaltimoreMarylandUSA
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6
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Duggal R, Davis RJ, Appachi S, Tierney WS, Hopkins BD, Bryson PC. Interdisciplinary assessment of tracheostomy care knowledge: An opportunity for quality improvement. Am J Otolaryngol 2023; 44:103865. [PMID: 37004318 DOI: 10.1016/j.amjoto.2023.103865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/19/2023] [Indexed: 04/03/2023]
Abstract
PURPOSE A 2013 AAOHNS consensus statement called for reduced variation in tracheostomy care. Multidisciplinary approaches and standardized protocols have been shown to improve tracheostomy outcomes. This study aims to identify inconsistencies in knowledge in order to design standardized education targeting these areas to improve quality of care. MATERIALS AND METHODS An online, multiple-choice tracheostomy care knowledge assessment was administered to nurses and respiratory therapists in ICUs, stepdown units, and regular nursing floors, as well as residents in otolaryngology, general surgery, and thoracic surgery. The survey was administered and data were recorded using the Select Survey online platform. RESULTS 173 nurses, respiratory therapists, and residents participated in this study. Over 75 % of respondents identified correct answers to questions addressing basic tracheostomy care, such as suctioning and humidification. Significant variation was observed in identification and management of tracheostomy emergencies, and appropriate use of speaking valves. Only 47 % of all respondents identified all potential signs of tracheostomy tube displacement. Respiratory therapists with over 20 years of experience (p = 0.001), were more likely to answer correctly than those with less. Nurses were less likely than respiratory therapists to have received standardized tracheostomy education (p = 0.006) and were less likely than others to choose the appropriate scenario for speaking valve use (p = 0.042), highlighting the need for interdisciplinary education. CONCLUSIONS An interdisciplinary assessment of tracheostomy care knowledge demonstrates variation, especially in identification and management of tracheostomy emergencies and appropriate use of speaking valves. Design of a standardized educational program targeting these areas is underway.
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Affiliation(s)
- Radhika Duggal
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, United States of America.
| | - Ruth J Davis
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Swathi Appachi
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Head and Neck Institute, Cleveland, OH, United States of America
| | - William S Tierney
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Head and Neck Institute, Cleveland, OH, United States of America
| | - Brandon D Hopkins
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Head and Neck Institute, Cleveland, OH, United States of America
| | - Paul C Bryson
- Department of Otolaryngology-Head and Neck Surgery, Cleveland Clinic Head and Neck Institute, Cleveland, OH, United States of America
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Kolethekkat AA, Al Salmi HZ, Al Abri HK, Al Abri R. Insights on Competency and Knowledge Related to the Tracheostomy Care of Nurses at a Tertiary Referral Hospital in Oman. Indian J Otolaryngol Head Neck Surg 2023; 75:737-743. [PMID: 37275066 PMCID: PMC10235375 DOI: 10.1007/s12070-022-03433-2] [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: 11/08/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
Objectives: To assess the efficacy of current knowledge and competency of tracheostomy care providers in inpatient setting. Methods: A real-time questionnaire-based cross-sectional study was carried out on 34 tracheostomy nursing care providers from different in patient settings. There were 50 questions in 8 sections, covering most of the aspects and steps of tracheostomy. The assessment of efficacy of the current knowledge and competency of tracheostomy care were assessed based on the response of the survey. Results: The overall competency of nursing for tracheostomy care was only 63.5%. In 5.9% of them, it was less than 50%. 30 (88.2%) tracheostomy care givers answered between 50% and 80% of the questionnaire correctly, and only 2 (5.9%) of them managed to get higher than 80%. Conclusion: The competency and knowledge regarding the tracheostomy care is low and the study highlight the importance of staff education for post-operative tracheostomy care to increase the level of care and to reduce adverse events. A re audit is needed to ensure that the care is improved qualitatively after training.
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Affiliation(s)
- Arif Ali Kolethekkat
- ENT Division, Department of Surgery, Sultan Qaboos University Hospital, P O 38, PC 123, Sib, AL Khoud Oman
| | | | | | - Rashid Al Abri
- ENT Division, Department of Surgery, Sultan Qaboos University Hospital, P O 38, PC 123, Sib, AL Khoud Oman
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8
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Multidisciplinary Pediatric Tracheostomy Teams. Otolaryngol Clin North Am 2022; 55:1195-1203. [DOI: 10.1016/j.otc.2022.07.005] [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]
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9
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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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10
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Pu SF, Boyle JV, Rubinstein BJ, Bak MJ, Brooke Hooper A, Mark JR. Video-Based Tracheostomy Care Education for Medical Students. OTO Open 2022; 6:2473974X221134267. [PMID: 36329804 PMCID: PMC9623382 DOI: 10.1177/2473974x221134267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022] Open
Abstract
Objective Tracheostomy is a common procedure that requires management by a multidisciplinary team of health care providers across a range of surgical and nonsurgical specialties. Nonsurgical health care providers have demonstrated a lack of knowledge and confidence in tracheostomy care, which improve with tracheostomy education programs. However, tracheostomy care is rarely included in preresidency medical education. The purpose of this study is to evaluate the effectiveness of a tracheostomy care video on third-year medical students' knowledge of and confidence in performing tracheostomy care. Methods Prior to beginning clinical rotations, third-year medical students completed a 10-question tracheostomy care knowledge test (100 points total) and 11-question confidence survey (110 points total). After watching an 18-minute teaching video on tracheostomy care, students repeated the knowledge test and confidence survey. Results An overall 147 medical students completed the educational module. After they watched the tracheostomy education video, their average score on the knowledge test improved from 57.8 to 88.9 out of 100 (P < .0001), and their average rating in confidence improved from 12.7 to 49.1 out of 110 (P < .0001). Students rated the helpfulness of the video a 7.4 out of 10. Discussion Medical students' knowledge of tracheostomy care and confidence in caring for patients with tracheostomies improved after watching the video. Tracheostomy education should be included in early medical education so that future physicians of various specialties can better care for this patient population. Implications for Practice Internet-published videos are an accessible educational resource with great potential application to various topics within otolaryngology, including tracheostomy care.
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Affiliation(s)
- Serena F. Pu
- Eastern Virginia Medical School,
Norfolk, Virginia, USA
- Serena F. Pu, Department of Otolaryngology,
Eastern Virginia Medical School, 600 Gresham Dr, Suite 1100, Norfolk, VA 23507,
USA.
| | - John V. Boyle
- Department of Otolaryngology, Eastern
Virginia Medical School, Norfolk, Virginia, USA
| | | | - Matthew J. Bak
- Department of Otolaryngology, Eastern
Virginia Medical School, Norfolk, Virginia, USA
| | - A. Brooke Hooper
- Department of Internal Medicine,
Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Jonathan R. Mark
- Department of Otolaryngology, Eastern
Virginia Medical School, Norfolk, Virginia, USA
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11
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Tiu RA, Meyer TK, Mayerhoff RM, Ray JC, Kritek PA, Merati AL, Sardesai MG. Tracheotomy care simulation training program for inpatient providers. Laryngoscope Investig Otolaryngol 2022; 7:1491-1498. [PMID: 36258878 PMCID: PMC9575083 DOI: 10.1002/lio2.912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives Tracheotomy complications can be life-threatening. Many of these complications may be avoided with proper education of health care providers. Unfortunately, access to high-quality tracheotomy care curricula is limited. We developed a program to address this gap in tracheotomy care education for inpatient providers. This study aimed to assess the efficacy of this training program in improving trainee knowledge and comfort with tracheotomy care. Methods The curriculum includes asynchronous online modules coupled with a self-directed hands-on simulation activity using a low-cost tracheotomy care task trainer. The program was offered to inpatient providers including medical students, residents, medical assistants, nurses, and respiratory therapists. Efficacy of the training was assessed using pre-training and post-training surveys of learner comfort, knowledge, and qualitative feedback. Results Data was collected on 41 participants. After completing the program, participants exhibited significantly improved comfort in performing tracheotomy care activities and 15% improvement in knowledge scores, with large effect sizes respectively and greater gains among those with little prior tracheotomy care experience. Conclusion This study has demonstrated that completion of this integrated online and hands-on tracheotomy simulation curriculum training increases comfort and knowledge, especially for less-experienced learners. This training addresses an important gap in tracheotomy care education among health care professionals with low levels of tracheotomy care experience and ultimately aims to improve patient safety and quality of care. This curriculum is easily transferrable as it requires only access to the online modules and low-cost simulation materials and could be used in other hospitals, long-term care facilities, outpatient clinics, and home settings. Level of evidence 4.
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Affiliation(s)
- Ryan Alyson‐Yao Tiu
- Department of Otolaryngology – Head and Neck SurgeryUniversity of WashingtonSeattleWashingtonUSA
| | - Tanya Kim Meyer
- Department of Otolaryngology – Head and Neck SurgeryUniversity of WashingtonSeattleWashingtonUSA
| | - Ross M. Mayerhoff
- Department of Otolaryngology – Head and Neck SurgeryHenry Ford Health SystemDetroitMichiganUSA
| | - Joel C. Ray
- Manager of Ancillary ServicesUW‐Valley Medical CenterRentonWashingtonUSA
| | - Patricia A. Kritek
- Division of Pulmonary, Critical Care and Sleep MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Albert Lincoln Merati
- Department of Otolaryngology – Head and Neck SurgeryUniversity of WashingtonSeattleWashingtonUSA
| | - Maya Guirish Sardesai
- Department of Otolaryngology – Head and Neck SurgeryUniversity of WashingtonSeattleWashingtonUSA
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12
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Mosalli R, Aboumoustafa GA, Khayyat W, Bokhari AN, Almatrafi MA, Ghazi M, Paes B. Assessment of Nurses' Knowledge and Confidence Regarding Tracheostomy Care in a Pediatric Long Term Care Hospital in Saudi Arabia. Risk Manag Healthc Policy 2022; 15:1809-1821. [PMID: 36171869 PMCID: PMC9512020 DOI: 10.2147/rmhp.s374730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 09/13/2022] [Indexed: 11/28/2022] Open
Abstract
Background The incidence of tracheostomy insertion in pediatric patients has increased over the last few decades. Tracheostomized pediatric patients need daily, meticulous care by qualified nurses to minimize severe, avoidable complications. Adequately trained nurses facilitate patients’ stability, accelerate weaning from the ventilator, and reduce potential tracheostomy dislodgement. Methods A cross-sectional, retrospective cohort survey was conducted in September 2021, using an electronic version of a self-questionnaire, to assess nurses’ knowledge and comfort level regarding tracheostomy care of pediatric patients at the International Extended Care Center in Jeddah, Saudi Arabia. Statistical analysis of the accrued data was performed using the SPSS 21.0 software package and a P-value <0.05 calculated by t-Test, was considered significant. Results Among 43 nurses included in the study, 14 (32.6%) were very comfortable taking care of tracheostomized patients, 13 (30.2%) were comfortable, and 16 (37.2%) were uncomfortable. Regarding knowledge, three main aspects of tracheostomy care were correctly answered (%) by all the nurses: knowledge of routine tracheal care (55%), tracheal care skills (11.6%), and tracheal emergency care (2.3%). The study showed a significant positive correlation between nurses’ comfort level with tracheal care and academic degree, duration of pediatric experience, completion of more than one life support course, and attendance at the annual local tracheostomy care competency learning program (TCCLP; all P <0.05). Conclusion Deficits exist in nurses’ knowledge of tracheostomy care. Improved knowledge garnered through repetitive participation in tracheostomy competency programs and life support courses correlate with greater comfort and more than 5 years of pediatric experience. Nurses’ deficits in emergency care knowledge and skills should be addressed through a structured educational program and a simulation, hands-on based TCCLP course, irrespective of comfort level with tracheostomy care.
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Affiliation(s)
- Rafat Mosalli
- Department of Pediatrics, International Extended Care Center, Jeddah, Saudi Arabia.,Department of Pediatrics, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Gamal A Aboumoustafa
- Department of Pediatrics, International Extended Care Center, Jeddah, Saudi Arabia
| | - Wed Khayyat
- Medical College, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Aziza N Bokhari
- Medical College, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | - Mohammed Ghazi
- Department of Pediatrics, International Extended Care Center, Jeddah, Saudi Arabia.,Department of Pediatrics, Division of Critical Care, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Bosco Paes
- Department of Pediatrics (Neonatal Division), McMaster University, Hamilton, Ontario, Canada
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13
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Shi JY, Orkin J, Walsh CM, Chu S, Keilty K, McKay S, Mocanu C, Qazi A, Ambreen M, Amin R. Pediatric Chronic Tracheostomy Care: An Evaluation of an Innovative Competency-Based Education Program for Community Health Care Providers. Front Pediatr 2022; 10:885405. [PMID: 35757113 PMCID: PMC9220937 DOI: 10.3389/fped.2022.885405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/05/2022] [Indexed: 11/27/2022] Open
Abstract
Objective To evaluate the immediate and sustained knowledge retention and sense of self-efficacy of homecare nurses following completion of a standardized competency-based tracheostomy education course. Safe discharge of children requiring tracheostomy with or without ventilation relies on the competence of homecare nurses. Study Design Pragmatic, randomized controlled trial of 44 homecare nurses. Participants were randomized into the intervention group (n = 21), which received the tracheostomy course, or the control group (n = 23), which received an enterostomy and vascular access course. Multiple-choice question (MCQ) knowledge assessments and self-efficacy questionnaires were administered to both groups pre-course and post-course at 6 week, 3 month, 6 month, and 12 month follow-ups. Results Twenty participants in the intervention group and 19 in the control group were included. Four withdrew from the study and two crossed over from the control into the intervention arm. The change in mean self-efficacy scores (total score = 100) was significantly higher in the intervention group than in the control group at 6 weeks (intervention (mean ± SD): 18.6 ± 14.5; control: 6.6 ± 20.4; p = 0.04) and 3 months (intervention: 19.6 ± 14.2; control: 5.2 ± 17.0; p = 0.007), and trended higher at 6 months (intervention: 18.0 ± 14.5; control: 6.9 ± 24.1; p = 0.1). The change in mean MCQ assessment scores (total score = 20) trended higher in the intervention group than in the control group at 6 weeks (intervention (mean ± SD): 1.8 ± 2.2; control: 1.6, ± 2.9; p = 0.8). Conclusions Homecare nurses who attended the tracheostomy course demonstrated a higher sense of self-efficacy at long-term follow-up. Clinical Trial Registration www.ClinicalTrials.gov, identifier: NCT04559932.
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Affiliation(s)
- Jenny Y. Shi
- Paediatric Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Julia Orkin
- Complex Care Program, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Catharine M. Walsh
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics and the SickKids Research and Learning Institutes, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Stephanie Chu
- Connected Care, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Krista Keilty
- Connected Care, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Cora Mocanu
- Paediatric Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Adam Qazi
- Paediatric Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Munazzah Ambreen
- Paediatric Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Reshma Amin
- Paediatric Respiratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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14
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Gardner LA, Jones R, Rassekh C, Atkins J. Tracheostomy and Laryngectomy Airway Safety Events: An Analysis of Patient Safety Reports From 84 Hospitals. PATIENT SAFETY 2022. [DOI: 10.33940/data/2022.3.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Tracheostomy- and laryngectomy-related airway safety events can lead to life-threatening situations, permanent harm, or death. We conducted a statewide population-based study to learn about these events and the relationship with associated factors, interventions, and outcomes to identify potential areas for improvement.
Methods: We queried the Pennsylvania Patient Safety Reporting System (PA-PSRS) to find tracheostomy- and laryngectomy-related airway safety event reports involving adults age 18 years and older that occurred between January 1, 2018, and December 31, 2020.
Results: Reports related to tracheostomies and laryngectomies accounted for 97.3% and 2.7% of the total, respectively. The four most frequent tracheostomy-related complications were unplanned decannulations, 71.4%; uncontrolled bleeding/hemorrhage, 9.2%; and partial/total occlusion and mucus plug/thick secretions, which each accounted for 6.9%.
Conclusions: Safe airway management for patients with a tracheostomy or laryngectomy requires staff who are knowledgeable and confident, and have the necessary skills and equipment to provide immediate attention when complications arise. We discuss potential safety strategies to reduce the risk of unplanned decannulations, uncontrolled bleeding/hemorrhage, and partial/total occlusions, as well as issues related to equipment, knowledge/training, and communication.
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15
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Uyan ZS, Atag E, Ergenekon AP, Gokdemir Y, Gokler O, Ay P, Bas İkizoglu N, Cenk M, Erdem Eralp E, Sivrikaya GU, Girit S, Cakir E, Kilic AA, Yazan H, Can Oksay S, Hepkaya E, Kiyan G, Karadag B, Karakoc F, Oktem S. Efficacy of standardized tracheostomy training with a simulation model for healthcare providers: A study by ISPAT team. Pediatr Pulmonol 2022; 57:418-426. [PMID: 34821480 DOI: 10.1002/ppul.25772] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/30/2021] [Accepted: 11/18/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Tracheostomy care in children may be challenging, due to lack of knowledge of healthcare providers (HCPs). The aim of this study was to determine the level of knowledge of HCP who follow patients with tracheostomy and to increase this level with theoretical training and training in a simulation laboratory. MATERIALS AND METHODS ISPAT (IStanbul PAediatric Tracheostomy), a multidisciplinary team for tracheostomy care was established and a training program was prepared. Participants were subjected to theoretical and practical pretests which evaluated their knowledge levels and skills for care, follow-up, and treatment of a patient with tracheostomy. After the theoretical and practical training given to the participants with a simulation model, theoretical and practical posttests were applied. RESULTS Fifty-one HCP from nine tertiary pediatric clinics in Istanbul were enrolled in the training program. Only six (11.8%) of them had received standardized training programs previously. Regarding the theoretical tests, seven of the 33 questions were indicated as essential. The knowledge level of the participants based on the essential questions significantly increased after the training (p < 0.05 for all of the essential questions). The total number of correct answers and correct answers of three subheadings also significantly increased after the practical training (p < 0.001 for all). Ninety-five percent of the participants assessed the course as good or excellent in general. CONCLUSION Training in a simulation laboratory in combination with theoretical education can improve the knowledge and skills of the HCP enabling improved care of children with a tracheostomy.
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Affiliation(s)
- Zeynep S Uyan
- Division of Pediatric Pulmonology, Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Emine Atag
- Division of Pediatric Pulmonology, Faculty of Medicine, Medipol University, Istanbul, Turkey
| | - Almala P Ergenekon
- Division of Pediatric Pulmonology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Yasemin Gokdemir
- Division of Pediatric Pulmonology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Ozan Gokler
- Department of Otorhinolaryngology, Faculty of Medicine, Koc University, Istanbul, Turkey
| | - Pinar Ay
- Department of Public Health, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Nilay Bas İkizoglu
- Division of Pediatric Pulmonology, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
| | - Muruvvet Cenk
- Division of Pediatric Pulmonology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Ela Erdem Eralp
- Division of Pediatric Pulmonology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - G Ulufer Sivrikaya
- Rahmi M. Koc Academy of Interventional Medicine, Education and Simulation (RMK AIMES), Istanbul, Turkey
| | - Saniye Girit
- Division of Pediatric Pulmonology, Faculty of Medicine, Medeniyet University, Istanbul, Turkey
| | - Erkan Cakir
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ayse A Kilic
- Division of Pediatric Pulmonology, Faculty of Medicine, Cerrahpasa University, Istanbul, Turkey
| | - Hakan Yazan
- Division of Pediatric Pulmonology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Sinem Can Oksay
- Division of Pediatric Pulmonology, Faculty of Medicine, Medeniyet University, Istanbul, Turkey
| | - Evrim Hepkaya
- Division of Pediatric Pulmonology, Faculty of Medicine, Cerrahpasa University, Istanbul, Turkey
| | - Gursu Kiyan
- Department of Pediatric Surgery, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Fazilet Karakoc
- Division of Pediatric Pulmonology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Sedat Oktem
- Division of Pediatric Pulmonology, Faculty of Medicine, Medipol University, Istanbul, Turkey
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16
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Chiang DH, Huang CC, Cheng SC, Cheng JC, Wu CH, Huang SS, Yang YY, Yang LY, Kao SY, Chen CH, Shulruf B, Lee FY. Immersive virtual reality (VR) training increases the self-efficacy of in-hospital healthcare providers and patient families regarding tracheostomy-related knowledge and care skills: A prospective pre-post study. Medicine (Baltimore) 2022; 101:e28570. [PMID: 35029229 PMCID: PMC8757958 DOI: 10.1097/md.0000000000028570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/23/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Virtual reality (VR)-based simulation in hospital settings facilitates the acquisition of skills without compromising patient safety. Despite regular text-based training, a baseline survey of randomly selected healthcare providers revealed deficiencies in their knowledge, confidence, comfort, and care skills regarding tracheostomy. This prospective pre-post study compared the effectiveness of regular text- and VR-based intervention modules in training healthcare providers' self-efficacy in tracheostomy care skills. METHODS Between January 2018 and January 2020, 60 healthcare providers, including physicians, nurses, and respiratory therapists, were enrolled. For the intervention, a newly developed head-mounted display (HMD) and web VR materials were implemented in training and clinical services. Subsequently, in-hospital healthcare providers were trained using either text or head-mounted display virtual reality (HMD-VR) materials in the regular and intervention modules, respectively. For tracheostomy care skills, preceptors directly audited the performance of trainees and provided feedback. RESULTS At baseline, the degree of trainees' agreement with the self-efficacy-related statements, including the aspects of familiarity, confidence, and anxiety about tracheostomy-related knowledge and care skills, were not different between the control and intervention groups. At follow-up stage, compared with the regular group, a higher percentage of intervention group' trainees reported that they are "strongly agree" or "somewhat agree" that the HMD-VR simulation increases their self-efficacy, including the aspects of familiarity and confidence, and reduced their anxiety about tracheostomy-related knowledge and care skills. After implementation, a higher degree of trainees' average satisfaction with VR-based training and VR materials was observed in the intervention group than in the regular group. Most reported that VR materials enabled accurate messaging and decreased anxiety. The increasing trend of the average written test and hands-on tracheostomy care skills scores among the intervention group trainees was significant compared to those in the regular group. The benefits of HMD-VR simulations and web-VR material-based clinical services for in-hospital healthcare providers and patient families persisted until 3 to 4 weeks later. CONCLUSION The current study suggests that VR materials significantly enhance trainees' self-efficacy (increased familiarity, increased confidence, and reduced anxiety) and their satisfaction with the training, while motivating them to use acquired knowledge and skills in clinical practice.
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Affiliation(s)
- Dung-Hung Chiang
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, Taipei, Taiwan
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Chang Huang
- Faculty of Medicine, Taipei, Taiwan
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Medical Innovation Research Office, Clinical Innovation Center, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shu-Chuan Cheng
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Division of Respiratory Therapy, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jui-Chun Cheng
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Division of Respiratory Therapy, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Hsien Wu
- Faculty of Medicine, Taipei, Taiwan
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shiau-Shian Huang
- Faculty of Medicine, Taipei, Taiwan
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Medical Innovation Research Office, Clinical Innovation Center, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ying-Ying Yang
- Faculty of Medicine, Taipei, Taiwan
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Medical Innovation Research Office, Clinical Innovation Center, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ling-Yu Yang
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shou-Yen Kao
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Division of Family Dentistry, Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Huan Chen
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | - Fa-Yauh Lee
- National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
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17
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Yilmaz Yegit C, Kilinc AA, Can Oksay S, Unal F, Yazan H, Köstereli E, Gulieva A, Arslan H, Uzuner S, Onay ZR, Kilic Baskan A, Collak A, Atag E, Ergenekon AP, Bas Ikizoğlu N, Ay P, Oktem S, Gokdemir Y, Girit S, Cakir E, Uyan ZS, Cokugras H, Karadag B, Karakoc F, Erdem Eralp E. The ISPAT project: Implementation of a standardized training program for caregivers of children with tracheostomy. Pediatr Pulmonol 2022; 57:176-184. [PMID: 34562057 DOI: 10.1002/ppul.25704] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/15/2021] [Accepted: 09/15/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Tracheostomy-related morbidity and mortality mainly occur due to decannulation, misplacement, or obstruction of the tube. A standardized training can improve the skills and confidence of the caregivers in tracheostomy care (TC). OBJECTIVE Our primary aim was to evaluate the efficiency of standardized training program on the knowledge and skills (changing-suctioning the tracheostomy tube) of the participants regarding TC. MATERIALS AND METHODS Sixty-five caregivers of children with tracheostomy were included. First, participants were evaluated with written test about TC and participated in the practical tests. Then, they were asked to participate in a standardized training session, including theoretical and practical parts. Baseline and postintervention assessments were compared through written and practical tests conducted on the same day. RESULTS A significant improvement was observed in the written test score after the training. The median number of correct answers of the written test including 23 questions increased 26%, from 12 to 18 (p < .001). The median number of correct steps in tracheostomy tube change (from 9 to 16 correct steps out of 16 steps, 44% increase) and suctioning the tracheostomy tube (from 9 to 17 correct steps out of 18 steps, 44% increase) also improved significantly after the training (p < .001, for both). CONCLUSION Theoretical courses and practical hands-on-training (HOT) courses are highly effective in improving the practices in TC. A standardized training program including HOT should be implemented before discharge from the hospital. Still there is a need to assess the impact of the program on tracheostomy-related complications, morbidity, and mortality in the long term.
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Affiliation(s)
- Cansu Yilmaz Yegit
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Ayse Ayzit Kilinc
- Division of Pediatric Pulmonology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Sinem Can Oksay
- Division of Pediatric Pulmonology, Istanbul Medeniyet University, Faculty of Health Sciences, Istanbul, Turkey
| | - Fusun Unal
- Division of Pediatric Pulmonology, Istanbul Medipol University, School of Medicine, Istanbul, Turkey
| | - Hakan Yazan
- Division of Pediatric Pulmonology, Istanbul Bezmialem University, School of Medicine, Istanbul, Turkey
| | - Ebru Köstereli
- Division of Pediatric Pulmonology, Koc University, School of Medicine, Istanbul, Turkey
| | - Aynur Gulieva
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Hüseyin Arslan
- Division of Pediatric Pulmonology, Istanbul Medipol University, School of Medicine, Istanbul, Turkey
| | - Selçuk Uzuner
- Division of Pediatrics, Istanbul Bezmialem University, School of Medicine, Istanbul, Turkey
| | - Zeynep Reyhan Onay
- Division of Pediatric Pulmonology, Istanbul Medeniyet University, Faculty of Health Sciences, Istanbul, Turkey
| | - Azer Kilic Baskan
- Division of Pediatric Pulmonology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Abdulhamit Collak
- Division of Pediatrics, Istanbul Bezmialem University, School of Medicine, Istanbul, Turkey
| | - Emine Atag
- Division of Pediatric Pulmonology, Istanbul Medipol University, School of Medicine, Istanbul, Turkey
| | - Almala Pinar Ergenekon
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Nilay Bas Ikizoğlu
- Division of Pediatric Pulmonology, Sureyyapasa Chest Diseases and Thoracic Surgery Training Hospital
| | - Pinar Ay
- Division of Public Health, Marmara University, School of Medicine, Istanbul, Turkey
| | - Sedat Oktem
- Division of Pediatric Pulmonology, Istanbul Medipol University, School of Medicine, Istanbul, Turkey
| | - Yasemin Gokdemir
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Saniye Girit
- Division of Pediatric Pulmonology, Istanbul Medeniyet University, Faculty of Health Sciences, Istanbul, Turkey
| | - Erkan Cakir
- Division of Pediatric Pulmonology, Istanbul Bezmialem University, School of Medicine, Istanbul, Turkey
| | - Zeynep Seda Uyan
- Division of Pediatric Pulmonology, Koc University, School of Medicine, Istanbul, Turkey
| | - Haluk Cokugras
- Division of Pediatric Pulmonology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Fazilet Karakoc
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Ela Erdem Eralp
- Division of Pediatric Pulmonology, Marmara University, School of Medicine, Istanbul, Turkey
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18
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Comparison of In-Person and Telesimulation for Critical Care Training during the COVID-19 Pandemic. ATS Sch 2021; 2:581-594. [PMID: 35083463 PMCID: PMC8787731 DOI: 10.34197/ats-scholar.2021-0053oc] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/29/2021] [Indexed: 12/28/2022] Open
Abstract
Background The coronavirus disease (COVID-19) pandemic has disrupted medical education
for trainees of all levels. Although telesimulation was initially used to
train in resource-limited environments, it may be a reasonable alternative
for replicating authentic patient experiences for medical students during
the COVID-19 pandemic. It is unclear whether a more passive approach through
telesimulation training is as effective as traditional in-person simulation
training. Objective Our aim was to evaluate the effectiveness of in-person versus remote
simulation training on learners’ comfort with managing critical care
scenarios. Methods This was a prospective observational cohort study assessing the impact of an
in-person versus remote simulation course on volunteer fourth-year medical
students from February to April 2021 at the University of California San
Diego School of Medicine. Precourse and postcourse surveys were performed
anonymously using an online secure resource. Results In the in-person learners, there was statistically significant improvement in
learner comfort across all technical, behavioral, and cognitive domains. In
remote learners, there was a trend toward improvement in self-reported
comfort across technical and cognitive domains in the telesimulation course.
However, the only statistically significant improvement in postcourse
surveys of telesimulation learners, compared with baseline, was in running
codes. Regardless of the training modality, the students had a positive
experience with the critical care simulation course, ranking it, on average,
9.6 out of 10 (9.9 in in-person simulation vs. 9.3 in telesimulation;
P = 0.06). Conclusion We demonstrated that implementation of a telesimulation-based simulation
course focusing on critical care cases is feasible and well received by
trainees. Although a telesimulation-based simulation course may not be as
effective for remote learners as active in-person participants, our study
provided evidence that there was still a trend toward improving provider
readiness across technical and cognitive domains when approaching critical
care cases.
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19
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Nielsen RP, Nikolajsen L, Paltved C, Aagaard R. Effect of simulation-based team training in airway management: a systematic review. Anaesthesia 2021; 76:1404-1415. [PMID: 33497486 DOI: 10.1111/anae.15375] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 12/01/2022]
Abstract
Major complications associated with airway management are rare but often have serious consequences. Complications frequently result from failures in communication and teamwork. We performed a systematic review on the effect of simulation-based team training on patient outcomes, healthcare professionals' clinical performance and preparedness for airway management. We included studies with simulation-based team training in airway management as the educational intervention, using any comparator, outcome and design. Two authors independently selected articles and assessed risk of bias using the Medical Education Research Study Quality Instrument and Newcastle-Ottawa Scale-Education. We screened 1248 titles and evaluated 116 full-text articles. Twenty-two studies were included. The Kirkpatrick model for evaluation of training was used to organise outcomes. Four studies reported patient-centred outcomes (Kirkpatrick level 4), and three studies' outcomes related to healthcare professionals' clinical performance (Kirkpatrick level 3). The results were ambiguous and the studies had significant methodological limitations, making it difficult to draw conclusions on the effect of simulation-based team training. To describe preparedness for airway management, we used outcomes related to participants' attitudes or perceptions and outcomes related to knowledge or skills demonstrated in a test setting (Kirkpatrick level 2). Most studies reporting these outcomes were in favour of simulation-based team training, but were prone to bias. We consider the current evidence to be weak and recommend that future research should be based on randomised study designs and patient-centred outcomes.
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Affiliation(s)
- R P Nielsen
- Department of Anaesthesiology and Intensive Care, Gødstrup Hospital, Herning, Denmark
| | - L Nikolajsen
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - C Paltved
- Corporate HR, MidtSim, Central Denmark Region, Denmark
| | - R Aagaard
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
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20
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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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22
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Benjamin J, Roy K, Paul G, Kumar S, Charles E, Miller E, Narsi-Prasla H, Mahan JD, Thammasitboon S. Improving Resident Self-Efficacy in Tracheostomy Management Using a Novel Curriculum. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:11010. [PMID: 33204834 PMCID: PMC7666842 DOI: 10.15766/mep_2374-8265.11010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 06/16/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Patients receiving pediatric tracheostomy have significant risk for mortality due to compromised airway. Timely management of airway emergencies in children with tracheostomies is an important clinical skill for pediatricians. We developed this curriculum to improve residents' self-efficacy with tracheostomy management. METHODS We collected baseline data on 67 residents from two hospitals while creating a blended curriculum with video-based instruction on routine tracheostomy change and team management of tracheostomy emergency. Forty residents enrolled in the curriculum. During an ICU rotation, they received face-to-face instruction on routine tracheostomy change in small groups, followed by assessment of managing a tracheostomy emergency during a simulation. A video completed prior to the simulation took 9 minutes, the routine tracheostomy change didactic session took 15 minutes, and the simulation instruction was completed in 10-15 minutes. We collected feedback on the effectiveness of the curriculum from the participants. RESULTS All 107 residents from the baseline and intervention groups completed the self-efficacy survey. The intervention group had significantly higher changes in scores across all self-efficacy domains than the baseline group. On the curriculum feedback survey, residents rated the curriculum very highly, between 4.4 and 4.8 on a 5-point Likert scale. DISCUSSION Our blended curriculum increased learners' self-efficacy and promoted learner competence in tracheostomy management. Residents scored more than 80% across all aspects of simulation assessment and reported higher self-efficacy scores following our curricular intervention.
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Affiliation(s)
- J. Benjamin
- Assistant Professor, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital
| | - K. Roy
- Medical Director-TICU, Baylor College of Medicine and Texas Children's Hospital; Assistant Professor of Pediatrics, Department of Pediatric ICU, Texas Children's Hospital and Baylor College of Medicine
| | - G. Paul
- Assistant Professor, Department of Pulmonology, Nationwide Children's Hospital and the Ohio State University College of Medicine
| | - S. Kumar
- Instructor, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital
| | - E. Charles
- Nurse Practitioner, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital
| | - E. Miller
- Nurse Practitioner, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital
| | - H. Narsi-Prasla
- Nurse Practitioner, Department of Otolaryngology, Baylor College of Medicine and Texas Children's Hospital
| | - J. D. Mahan
- Associate Director, Center for Faculty Advancement, Mentoring and Engagement (FAME), the Ohio State University College of Medicine; Professor, Department of Pediatrics, Nationwide Children's Hospital and the Ohio State University College of Medicine; Program Director, Pediatric Nephrology Fellowship Programs, Nationwide Children's Hospital and the Ohio State University College of Medicine
| | - S. Thammasitboon
- Associate Professor and Director, Center for Research, Innovation and Scholarship (CRIS) in Medical Education, Baylor College of Medicine and Texas Children's Hospital
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Abstract
PURPOSE OF REVIEW The aim of this review is to provide an update on the management of pediatric tracheostomies. RECENT FINDINGS Recent literature has focused on optimization of care for children with tracheostomies including prevention and management of skin breakdown, timing of tracheostomy tube changes, the role of multidisciplinary and team-based approaches to education and management of tracheostomy patients, ideal timing of surveillance endoscopy, and the emerging role of telemedicine in the care of tracheostomy patients. SUMMARY A focus on quality improvement and a systematic, team-based approach to care has the potential to improve the quality of care for pediatric tracheostomy patients.
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Roof SA, Gray M, Meyer A, Ferrandino RM, Eden C, Kirke D, Courey MS. An Interactive Workshop to Increase Comfort and Knowledge Regarding Adult Tracheostomy Management: A Pilot Study. JOURNAL OF SCIENTIFIC INNOVATION IN MEDICINE 2020. [DOI: 10.29024/jsim.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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25
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Brenner MJ, Pandian V, Milliren CE, Graham DA, Zaga C, Morris LL, Bedwell JR, Das P, Zhu H, Lee Y. Allen J, Peltz A, Chin K, Schiff BA, Randall DM, Swords C, French D, Ward E, Sweeney JM, Warrillow SJ, Arora A, Narula A, McGrath BA, Cameron TS, Roberson DW. Global Tracheostomy Collaborative: data-driven improvements in patient safety through multidisciplinary teamwork, standardisation, education, and patient partnership. Br J Anaesth 2020; 125:e104-e118. [PMID: 32456776 DOI: 10.1016/j.bja.2020.04.054] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/17/2020] [Accepted: 04/17/2020] [Indexed: 01/15/2023] 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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Kligerman MP, Saraswathula A, Sethi RK, Divi V. Tracheostomy Complications in the Emergency Department: A National Analysis of 38,271 Cases. ORL J Otorhinolaryngol Relat Spec 2020; 82:106-114. [PMID: 32036376 DOI: 10.1159/000505130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/28/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Greater than 100,000 tracheotomies are performed annually in the USA, yet little is known regarding patients who present to the emergency department (ED) with tracheostomy complications. OBJECTIVES To characterize patient and hospital characteristics, outcomes, and charges associated with tracheostomy complications and to identify predictors of admission and mortality. METHODS The 2009-2011 Nationwide Emergency Department Sample (NEDS) was queried for patients with a principle diagnosis of tracheostomy complication. A descriptive analysis was performed and multivariable logistic regression was used to identify predictors of admission and mortality. RESULTS A total of 69,371 nationwide visits to the ED had tracheostomy complication as an associated ICD-9 diagnosis, of which 55.2% (n = 38,293) carried a primary diagnosis of tracheostomy complication. Unspecified tracheostomy complications were most common (61.4%), followed by mechanical complications (31.3%), and lastly by tracheostomy infections (7.3%). Pediatric patients were significantly more likely to have tracheostomy infections than adults (p < 0.0001). A total of 35.5% of patients with tracheostomy complications were admitted to the hospital, and death occurred with 1.4% of visits. Patients from higher-income ZIP codes had increased odds of admission (adjusted odds ratio [OR]: 1.35; p = 0.0009), as did patients with tracheostomy infections (OR: 4.425; p < 0.0001). Patients with tracheostomy infections (OR: 3.14; p = 0.0062) and unspecified tracheostomy complications (OR: 2.00; p = 0.0076) had increased odds of mortality. CONCLUSION These findings may help improve overall outcomes amongst patients with tracheostomies by preventing unnecessary ED admissions and improving healthcare provider preparedness and awareness.
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Affiliation(s)
- Maxwell P Kligerman
- Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, California, USA,
| | - Anirudh Saraswathula
- Department of Otolaryngology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rosh K Sethi
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Vasu Divi
- Department of Otolaryngology - Head and Neck Surgery, Stanford University, Stanford, California, USA
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Using Didactics and Simulation to Enhance Comfort, Knowledge, and Skills of Nonsurgical Trainees Caring for Patients With Tracheostomy and Laryngectomy. Simul Healthc 2019; 14:384-390. [PMID: 31804423 DOI: 10.1097/sih.0000000000000392] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Management of tracheostomy and laryngectomy is an important skill for physicians who often care for patients with multiple, comorbid, chronic medical conditions. There is little published literature on training for tracheostomy and laryngectomy care during nonsurgical specialty residencies. This project was designed to assess and improve comfort with, knowledge of, proficiency in tracheostomy and laryngectomy care. METHODS This prospective observational study comprised 122 physician trainees from internal medicine, emergency medicine, and anesthesia training programs at the University of Arkansas for Medical Sciences participating in a simulation-based curriculum from April 2016 to December 2016. The curriculum included didactic session, hands-on experience performing a tracheostomy change, and practicing emergency scenarios on interactive, high-fidelity simulation mannequins. Preintervention and postintervention assessments of self-perceived comfort, objective knowledge, and tracheostomy change proficiency were performed and results compared. RESULTS Self-perceived comfort improved from a mean Likert score from 2.12 to 4.43 (P = 0.009). Knowledge mean scores improved from 57% to 82% (P < 0.001) on multiple-choice testing. Tracheostomy change proficiency mean scores improved from 41% to 84% (P < 0.001) of proficiencies correctly performed. Six-month follow-up assessment of comfort and knowledge showed statistically significant retention of comfort (P = 0.002) and knowledge (P = 0.026). CONCLUSIONS Comprehensive tracheostomy and laryngectomy education, which combines enhancement of knowledge with simulation of both routine and emergent aspects of care, is an effective strategy in improving confidence with, knowledge of, proficiency in tracheostomy and laryngectomy care. Retention of confidence and knowledge was demonstrated 6 months later.
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Sandler ML, Ayele N, Ncogoza I, Blanchette S, Munhall DS, Marques B, Nuss RC. Improving Tracheostomy Care in Resource-Limited Settings. Ann Otol Rhinol Laryngol 2019; 129:181-190. [PMID: 31631687 DOI: 10.1177/0003489419882972] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Tracheostomy care in leading pediatric hospitals is both multidisciplinary and comprehensive, including generalized care protocols and thorough family training programs. This level of care is more difficult in resource-limited settings lacking developed healthcare infrastructure and tracheostomy education among nursing and resident staff. The objective of this study was to improve pediatric tracheostomy care in resource-limited settings. METHODS In collaboration with a team of otolaryngologists, respiratory therapists, tracheostomy nurses, medical illustrators, and global health educators, image-based tracheostomy education materials and low-cost tracheostomy care kits were developed for use in resource-limited settings. In addition, a pilot study was conducted, implementing the image-based tracheostomy pamphlet, manual suctioning device and low-cost ambulatory supply kit ("Go-Bags"), within a low-fidelity simulated training course for nurses and residents in Kigali, Rwanda. RESULTS An image-based language and literacy-independent tracheostomy care manual was created and published on OPENPediatrics, an open-access online database of clinician-reviewed learning content. Participants of the training program pilot study reported the course to be of high educational and practical value, and described improved confidence in their ability to perform tracheostomy care procedures. CONCLUSIONS Outpatient tracheostomy care may be improved upon by implementing image-based tracheostomy care manuals, locally-sourced tracheostomy care kits, and tailored educational material into a low-fidelity simulated tracheostomy care course. These materials were effective in improving technical skills and confidence among nurses and residents. These tools are expected to improve knowledge and skills with outpatient tracheostomy care, and ultimately, to reduce tracheostomy-related complications.
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Affiliation(s)
- Mykayla L Sandler
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Nohamin Ayele
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Isaie Ncogoza
- Department of Otolaryngology, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - Susan Blanchette
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Daphne S Munhall
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Brittanie Marques
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Roger C Nuss
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
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Hsieh TY, Timbang L, Kuhn M, Brodie H, Squires L. Assessment of Tracheostomy and Laryngectomy Knowledge among Non-Otolaryngology Physicians. Ann Otol Rhinol Laryngol 2019; 129:115-121. [DOI: 10.1177/0003489419877198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Identify knowledge deficits about alternate airways (AAs) (tracheostomy and laryngectomy) among physicians across multiple specialties a tertiary institution and to assess the impact of an educational lecture on improving deficits. Methods: Study Design: Cross-sectional assessment. Setting: Academic medical center. Subjects and Methods: An anonymous 10-item, multiple choice assessment was given to physicians at a tertiary care center in the departments of Otolaryngology, Emergency Medicine, Family Medicine, General Surgery, Internal Medicine, and Pediatrics. An educational lecture on AAs was presented. Scores between a pre-lecture and a 3-month post-lecture assessment were compared. Data was analyzed using ANOVA and chi-squared analysis. Results: Otolaryngology physicians scored an average of 97.8%, while non-otolaryngology physicians scored 58.3% ( P < .05). Non-otolaryngology surgical physicians scored 68.4% while non-surgical physicians were lower at 55.1% ( P < .0001). Comparing pre-lecture to post-lecture scores, all non-otolaryngology physicians improved their scores significantly from 58.3% to 86.5% ( P < .005). Non-surgical physicians had significant improvement after the instructional lecture, closing the score gap with surgical physicians for the post-lecture assessment. Discussion: The care of patients with AAs requires an understanding of their basic principles. Our findings identify significant knowledge deficits among non-otolaryngologists. Through an instructional lecture, we demonstrated improvement in knowledge among non-otolaryngology physicians and durability of the knowledge after 3 months. Conclusions: Through an instructional lecture, we found tracheostomy and laryngectomy knowledge deficits can be identified and improved upon. Periodic reinforcement of basic principles for non-otolaryngology physicians may be a promising strategy to ensure the proper care of patients with AAs.
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Affiliation(s)
- Tsung-yen Hsieh
- Department of Otolaryngology—Head and Neck Surgery, University of California, Davis, Medical Center, Sacramento, CA, USA
| | - Leah Timbang
- School of Medicine, University of California, Medical Center, Sacramento, CA, USA
| | - Maggie Kuhn
- Department of Otolaryngology—Head and Neck Surgery, University of California, Davis, Medical Center, Sacramento, CA, USA
| | - Hilary Brodie
- Department of Otolaryngology—Head and Neck Surgery, University of California, Davis, Medical Center, Sacramento, CA, USA
| | - Lane Squires
- Department of Otolaryngology—Head and Neck Surgery, University of California, Davis, Medical Center, Sacramento, CA, USA
- Veterans Affairs Northern California Healthcare System, Mather, CA, USA
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McKelvie BL, Lobos AT, Chan J, Momoli F, McNally JD. High Rate of Medical Emergency Team Activation in Children with Tracheostomy. J Pediatr Intensive Care 2019; 9:27-33. [PMID: 31984154 DOI: 10.1055/s-0039-1695733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/19/2019] [Indexed: 10/26/2022] Open
Abstract
Pediatric in-patients with tracheostomy (PIT) are at high risk for clinical deterioration. Medical emergency teams (MET) have been developed to identify high-risk patients. This study compared MET activation rates between PITs and the general ward population. This was a retrospective cohort study conducted at a tertiary pediatric hospital. The primary outcome (MET activation) was obtained from a database. Between 2008 and 2014, the MET activation rate was significantly higher in the PIT group than the general ward population (14 vs. 2.9 per 100 admissions, p < 0.001). PITs are at significantly higher risk for MET activation. Strategies should be developed to reduce their risk on the wards.
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Affiliation(s)
- Brianna L McKelvie
- Division of Critical Care, Department of Pediatrics, Faculty of Medicine, Western University, Children's Hospital-London Health Sciences Centre, London, Ontario, Canada
| | - Anna-Theresa Lobos
- Division of Critical Care, Department of Pediatrics, Faculty of Medicine, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Jason Chan
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Franco Momoli
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - James Dayre McNally
- Division of Critical Care, Department of Pediatrics, Faculty of Medicine, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
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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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Ramsey AM, Brennan S, Stricker A, Riek K, Brown D, Gurtowsky R, Sturza J, Filbrun AG. Emergency airway and ventilator procedures for community based home care staff validation of an educational program. Pediatr Pulmonol 2018; 53:374-380. [PMID: 29314751 DOI: 10.1002/ppul.23936] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 11/15/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Children discharged home with tracheostomy and chronic mechanical ventilator support are at high risk for complications and adverse events. Private duty nursing and home respiratory care services are a critical support necessary for successful discharge. The literature suggests that there are opportunities for home care staff (HCS) to improve upon the skills necessary to assess and intervene in an emergency thereby increasing the likelihood of improving long-term outcomes. METHODS HCS (RN, LPN, RRT) participated in a 4-h session comprised of lecture and simulation. Lecture content focused on tracheostomy safety, operation of the Trilogy and LTV home ventilators, and review of their common alarms. Simulation included two scenarios simulating tracheostomy decannulation and mucous plugging events. Participant comfort with tracheostomy and ventilator management skills were measured on a five item self-assessment tool and clinical knowledge was measured using an 11 item multiple choice skills test, both of which were completed before and after the session. We tested to see if there was a change in test scores from pre- to post-intervention. RESULTS Fifty-four HCS participated in the program and provided complete data sets. The vast majority (68%) were registered nurses, followed by licensed practical nurses (19%) and respiratory therapists (12%). Participant self-reported comfort with emergency skills prior to intervention was 3.2/5 which increased to 4.1/5 after intervention (P > 0.0001). Average test score prior to intervention was 62%, post intervention score increased to 82% which represented significant improvement (P > 0.0001). DISCUSSION HCS are generally unprepared to intervene in an acute airway or ventilator emergency. This short, manageable program provided education that resulted in a significant improvement in both skill level and confidence.
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Affiliation(s)
- Ann Marie Ramsey
- Pediatric Home Ventilator Program, Division of Pediatric Pulmonology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Sarah Brennan
- Department of Nursing, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Adam Stricker
- Pediatric Home Ventilator Program, Division of Pediatric Pulmonology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Kurt Riek
- Pediatric Home Ventilator Program, Division of Pediatric Pulmonology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Dana Brown
- Pediatric Home Ventilator Program, Division of Pediatric Pulmonology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Rachel Gurtowsky
- Pediatric Home Ventilator Program, Division of Pediatric Pulmonology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Julie Sturza
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Amy Goldstein Filbrun
- Pediatric Home Ventilator Program, Division of Pediatric Pulmonology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
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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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Open tracheostomy training: a nationwide survey among Otolaryngology-Head and Neck Surgery residents. Eur Arch Otorhinolaryngol 2017; 274:4035-4042. [PMID: 28936545 DOI: 10.1007/s00405-017-4751-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 09/19/2017] [Indexed: 12/30/2022]
Abstract
The aim of this study was to examine the training methods and needs of Otolaryngology-Head and Neck Surgery (OTO-HNS) residents to independently perform open tracheostomy (OT). An anonymous 26-items questionnaire pertaining to OT teaching aspects was distributed to all 93 Israeli OTO-HNS residents during March-June 2016. Residents were categorized as 'juniors,' if they were in their post-graduate year (PGY)-1 and PGY-2; 'mid-residency' (PGY-3 and PGY-4); or 'seniors' (PGY-5 and PGY-6). Response rate was 74% (n = 69). There were 25 'juniors' (36%), 24 'mid-residency' (35%) and 20 'seniors' (29%). Overall, the responses of the 3 groups were similar. Forty-seven (68%) residents estimated that there are ≥ 50 tracheostomies/year in their hospital, which roughly corresponds to an exposure of ~ 8 tracheostomies/year/resident. There was an inconsistency between the number of teaching hours given and the number of hours requested for OT training (23% received ≥ 5 h, but 82% declared they needed ≥ 5 h). Eighty-two percentage reported that their main training was conducted during surgery with peer residents or senior physicians. Forty-five (65%) feel competent to perform OT, including juniors. Due to the need to perform OT in urgent scenarios, the competency of OTO-HNS resident is crucial. Training for OT in Israeli OTO-HNS residency programs is not well structured. Yet, residents reported they feel confident to perform OT, already in the beginning of their residency. Planned educational programs to improve OT training should be done in the beginning of the residency and may include designated 'hands-on' platforms; objective periodic surgical competence assessments; and specialist's feedback, using structured assessment forms.
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Raimondi N, Vial MR, Calleja J, Quintero A, Cortés Alban A, Celis E, Pacheco C, Ugarte S, Añón JM, Hernández G, Vidal E, Chiappero G, Ríos F, Castilleja F, Matos A, Rodriguez E, Antoniazzi P, Teles JM, Dueñas C, Sinclair J, Martínez L, Von der Osten I, Vergara J, Jiménez E, Arroyo M, Rodriguez C, Torres J, Fernandez-Bussy S, Nates JL. Evidence-based guides in tracheostomy use in critical patients. Med Intensiva 2017; 41:94-115. [PMID: 28188061 DOI: 10.1016/j.medin.2016.12.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 11/20/2016] [Accepted: 12/02/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Provide evidence based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. METHODS A task force composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified of which 226 publications were chosen. The task force generated a total of 19 recommendations: 10 positive (1B=3, 2C=3, 2D=4) and 9 negative (1B=8, 2C=1). A recommendation was not possible in six questions. CONCLUSION Percutaneous techniques are associated with a lower risk of infections compared to surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used.
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Affiliation(s)
- N Raimondi
- Hospital Municipal Juan A. Fernández, Universidad de Buenos Aires, Argentina
| | - M R Vial
- MD Anderson Cancer Center, The University of Texas, Texas, United States; Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - J Calleja
- Hospital Zambrano Hellion, Instituto Tecnológico de Monterrey, Monterrey, Nuevo León, México
| | - A Quintero
- Instituto Medico de Alta Tecnología, Universidad del Sinú, Montería, Colombia
| | - A Cortés Alban
- Clínica Mayor de Temuco, Hospital de Nueva Imperial, Universidad Mayor de Temuco, Temuco, Chile
| | - E Celis
- Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Colombia
| | - C Pacheco
- Hospital Universitario de Caracas, Caracas, Venezuela
| | - S Ugarte
- Hospital del Salvador, Clínica Indisa, Universidad de Chile, Santiago, Chile
| | - J M Añón
- Hospital Universitario la Paz -Carlos III. IdiPaz, Madrid, España
| | - G Hernández
- Complejo Hospitalario de Toledo, Toledo, España
| | - E Vidal
- Hospital Ángeles Lomas, Hospital Español de México, Ciudad de México, México
| | - G Chiappero
- Hospital Juan A. Fernández CABA, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - F Ríos
- Hospital Nacional Alejandro Posadas, Sanatorio Las Lomas, San Isidro, Buenos Aires, Argentina
| | - F Castilleja
- Hospital Zambrano Hellion, Instituto Tecnológico de Monterrey, Monterrey, Nuevo León, México
| | - A Matos
- Complejo Hospitalario Caja de Seguro Social, Panamá
| | - E Rodriguez
- Complejo Hospitalario Caja de Seguro Social, Panamá
| | - P Antoniazzi
- Hospital Santa Casa, Ribeirao Preto, Sao Paulo, Brazil
| | - J M Teles
- Hospital de Urgências de Goiânia, Goiás, Brazil
| | - C Dueñas
- Gestión Salud, Santa Cruz de Bocagrande, Universidad de Cartagena, Cartagena, Colombia
| | - J Sinclair
- Hospital Punta Pacífica, Johns Hopkins Medicine, Universidad de Panamá, Ciudad de Panamá, Panamá
| | - L Martínez
- Hospital Policlínica Metropolitana, Caracas, Venezuela
| | - I Von der Osten
- Hospital Central "Miguel Pérez Carreño" IVSS, Universidad Central de Venezuela, Caracas, Venezuela
| | - J Vergara
- Hospital Luis Vernaza, Universidad de Especialidades Espíritu Santo "UEES", Guayaquil, Ecuador
| | - E Jiménez
- Baylor Scott & White Health, Texas A&M Health Science Center College of Medicine, Temple, Texas, Estados Unidos
| | - M Arroyo
- Clínica Santa Sofía, Caracas, Venezuela
| | - C Rodriguez
- Instituto Medico de Alta Tecnología, Universidad del Sinú, Montería, Colombia
| | - J Torres
- Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - S Fernandez-Bussy
- Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile; Division of Pulmonary, Critical Care & Sleep Medicine, University of Florida, Gainesville, Florida, Estados Unidos
| | - J L Nates
- MD Anderson Cancer Center, The University of Texas, Texas, United States.
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39
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Raimondi N, Vial MR, Calleja J, Quintero A, Cortés A, Celis E, Pacheco C, Ugarte S, Añón JM, Hernández G, Vidal E, Chiappero G, Ríos F, Castilleja F, Matos A, Rodriguez E, Antoniazzi P, Teles JM, Dueñas C, Sinclair J, Martínez L, von der Osten I, Vergara J, Jiménez E, Arroyo M, Rodríguez C, Torres J, Fernandez-Bussy S, Nates JL. Evidence-based guidelines for the use of tracheostomy in critically ill patients. J Crit Care 2016; 38:304-318. [PMID: 28103536 DOI: 10.1016/j.jcrc.2016.10.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To provide evidence-based guidelines for tracheostomy in critically ill adult patients and identify areas needing further research. METHODS A taskforce composed of representatives of 10 member countries of the Pan-American and Iberic Federation of Societies of Critical and Intensive Therapy Medicine and of the Latin American Critical Care Trial Investigators Network developed recommendations based on the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS The group identified 23 relevant questions among 87 issues that were initially identified. In the initial search, 333 relevant publications were identified, of which 226 publications were chosen. The taskforce generated a total of 19 recommendations, 10 positive (1B, 3; 2C, 3; 2D, 4) and 9 negative (1B, 8; 2C, 1). A recommendation was not possible in 6 questions. CONCLUSIONS Percutaneous techniques are associated with a lower risk of infections compared with surgical tracheostomy. Early tracheostomy only seems to reduce the duration of ventilator use but not the incidence of pneumonia, the length of stay, or the long-term mortality rate. The evidence does not support the use of routine bronchoscopy guidance or laryngeal masks during the procedure. Finally, proper prior training is as important or even a more significant factor in reducing complications than the technique used.
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Affiliation(s)
- Néstor Raimondi
- Hospital Municipal Juan A. Fernández, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Macarena R Vial
- MD Anderson Cancer Center, The University of Texas, Houston, TX, USA; Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - José Calleja
- Hospital Zambrano Hellion, Instituto Tecnológico de Monterrey, Monterrey, México
| | - Agamenón Quintero
- Instituto Médico de Alta Tecnología, Universidad del Sinú, Montería, Córdoba, Colombia
| | - Albán Cortés
- Clínica Mayor de Temuco, Hospital de Nueva Imperial, Universidad Mayor de Temuco, Temuco, Chile
| | - Edgar Celis
- Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá, Colombia
| | - Clara Pacheco
- Hospital Universitario de Caracas, Caracas, Venezuela
| | - Sebastián Ugarte
- Hospital del Salvador, Clínica Indisa, Universidad de Chile, Santiago, Chile
| | - José M Añón
- Hospital Universitario La Paz-Carlos III. IdiPaz, Madrid, Spain
| | | | - Erick Vidal
- Hospital Ángeles Lomas, Hospital Español de México, Ciudad de México, México
| | - Guillermo Chiappero
- Hospital Juan A. Fernández CABA, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Fernando Ríos
- Hospital Nacional Alejandro Posadas, Sanatorio Las Lomas, San Isidro, Buenos Aires, Argentina
| | - Fernando Castilleja
- Hospital Zambrano Hellion, Instituto Tecnológico de Monterrey, Monterrey, México
| | - Alfredo Matos
- Complejo Hospitalario Caja de Seguro Social, Ciudad de Panamá, Panamá
| | - Enith Rodriguez
- Complejo Hospitalario Caja de Seguro Social, Ciudad de Panamá, Panamá
| | - Paulo Antoniazzi
- Hospital Santa Casa de Ribeirão Preto, Centro Universitário Barao de Maua, São Paulo, Brazil
| | | | - Carmelo Dueñas
- Gestión Salud, Santa Cruz de Bocagrande, Universidad de Cartagena, Cartagena, Colombia
| | - Jorge Sinclair
- Hospital Punta Pacífica, Johns Hopkins Medicine, Universidad de Panamá, Ciudad de Panamá, Panamá
| | | | - Ingrid von der Osten
- Hospital Central "Miguel Pérez Carreño" IVSS, Universidad Central de Venezuela, Caracas, Venezuela
| | - José Vergara
- Hospital Luis Vernaza, Universidad de Especialidades Espíritu Santo "UEES,", Guayaquil, Ecuador
| | - Edgar Jiménez
- Baylor Scott & White Health, Texas A&M Health Science Center College of Medicine, Temple, TX, USA
| | | | - Camilo Rodríguez
- Instituto Médico de Alta Tecnología, Universidad del Sinú, Montería, Córdoba, Colombia
| | - Javier Torres
- Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - Sebastián Fernandez-Bussy
- Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile; Division of Pulmonary, Critical Care & Sleep Medicine, University of Florida, Gainesville, FL
| | - Joseph L Nates
- MD Anderson Cancer Center, The University of Texas, Houston, TX, USA.
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Agarwal A, Marks N, Wessel V, Willis D, Bai S, Tang X, Ward WL, Schellhase DE, Carroll JL. Improving knowledge, technical skills, and confidence among pediatric health care providers in the management of chronic tracheostomy using a simulation model. Pediatr Pulmonol 2016; 51:696-704. [PMID: 26681655 DOI: 10.1002/ppul.23355] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 10/17/2015] [Accepted: 11/16/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The results from a recent national survey about catastrophic complications following tracheostomy revealed that the majority of events involved a loss of airway. Most of the events due to airway loss involved potentially correctable deficits in caregiver education. Training in a simulated environment allows skill acquisition without compromising patient safety. We assessed the knowledge and confidence level of pediatric health care providers at a large tertiary care children's hospital in routine and emergency tracheostomy care and evaluated the efficacy of a comprehensive simulation-based tracheostomy educational program. METHODS The prospective observational study was comprised of 33 subjects including pediatric residents, internal medicine-pediatric residents, pediatric hospitalist faculty physicians, and advanced practice registered nurses who are involved in the care of patients with tracheostomies within a tertiary-care children's hospital. The subjects completed self-assessment questionnaires and objective multiple-choice tests before and after attending a comprehensive educational course that employed patient simulation. The outcome measurements included pre- and post-course questionnaires, pre- and post-course test scores, and observational data from the simulation sessions. RESULTS Before the education and simulation, the subjects' comfort and confidence levels on a five-point Likert scale in performing routine tracheostomy tube care, routine tracheostomy tube change, and an emergency tracheostomy tube change were as follows (median (Q1, Q3)): 1 (1, 2), 1 (1, 2), and 1 (1, 2), respectively (n = 28). The levels of comfort and confidence after completing the course improved significantly to 4 (4, 5), 4 (4, 5), 4 (4, 5), respectively (P < 0.001) (n = 20). For the knowledge assessment, the pre-course test mean score was 0.53 ± 0.50, and the scores on the post-course test improved significantly with a mean score of 0.82 ± 0.39 (P < 0.001). During the educational intervention, specific deficiencies observed included a lack of understanding or familiarity with different types of tracheostomy tubes (e.g., cuffed versus uncuffed), physiological significance of the cuff, mechanism of action and physiological significance of the speaking valve, and the importance of the obturator in changing the tracheostomy tube. CONCLUSION There is a need for improved tracheostomy education among pediatric health care providers. Incorporation of patient-simulation into a tracheostomy educational program was effective in improving knowledge, confidence, and skills. Pediatr Pulmonol. 2016;51:696-704. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Amit Agarwal
- Division of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Nancy Marks
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Arkansas Children's Hospital, Little Rock, Arkansas
| | - Valerie Wessel
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Denise Willis
- Respiratory Care Services, Arkansas Children's Hospital, Little Rock, Arkansas
| | - Shasha Bai
- Division of Biostatistics, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Xinyu Tang
- Division of Biostatistics, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Wendy L Ward
- Division of Psychology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Dennis E Schellhase
- Division of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - John L Carroll
- Division of Pediatric Pulmonary and Sleep Medicine, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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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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