New Tracheostomy Guidance launched for UK Critical Care
The patient population in NHS hospitals that are managed with a tracheostomy has evolved significantly over the last 20 years. The majority are performed percutaneously by intensivists, in the Intensive Care Unit, on critically ill patients or those recovering from critical illness. Most tracheostomies are temporary. The vast majority of patients with ‘surgical’ and ‘non-surgical’ tracheostomies experience critical care at some stage of their journey. The multidisciplinary nature of tracheostomy care is a familiar working environment for our speciality, with tracheostomy care being perhaps one of the best examples truly multidisciplinary care.
There is increasing evidence from national and international quality improvement programs that a multidisciplinary tracheostomy team that reviews and coordinates the management of tracheostomy patients can bring benefits for the quality and safety of care, including organisational efficiencies and significant cost savings.
All patients with tracheostomies admitted to critical care units should expect safe care to be delivered by appropriately trained, equipped and supported staff. Patient-centred high-quality care also focusses on communication, vocalisation, mobilisation, information and a prompt return to oral intake. Improving the quality and safety of patients with tracheostomies and laryngectomies is a hospital-wide issue, and our speciality is well placed to lead and to contribute to the safe management of this vulnerable patient group.
International quality improvement efforts should be supported. The key drivers of the Global Tracheostomy Collaborative (GTC) are examples of the hospital-wide changes that are required, which will involve and impact the ICU. The GTC key drivers are:
1. Multidisciplinary team-based care: Multidisciplinary tracheostomy team replacing siloed care, meeting face-to-face to coordinate and plan care, overcoming barriers to effective communication between providers. Such team-based care has been shown to reduce adverse events, length of stay, time to decannulation, increase speaking valve use and facilitate patient communication.
2. Standardisation of care: Standardised care protocols provide consistency in care, environment, equipment, and patient and provider expectations. Instituting such pathways and procedures promotes coordinated care, increases efficiency, and improves outcomes in airway emergencies.
3. Broad staff education: All patient encounters must involve healthcare staff who have been appropriately trained in tracheostomy care. Educational interventions have demonstrated marked improvement in objective knowledge and confidence with providing tracheostomy care, translating into safer patient care.
4. Patient and family involvement: Patients, their family and their carers are engaged in QI. Prioritising patient-centred care identifies key clinical outcomes, performance measures, and improvement areas that may otherwise not have been recognised.
5. Patient-level data: Hospitals track outcomes using a prospective database with detailed patient-level data captured each tracheostomy admission. Analytics allow the multidisciplinary team to benchmark over time and anonymously with peers within the Collaborative to assess the impact of initiatives.