Volume 13 Issue 1 - 2020

The Improving Tracheostomy Care (ITC) Quality Improvement (QI) programme is a national initiative aiming improve care by incorporating best practice initiatives from the Global Tracheostomy Collaborative (GTC) into 20 diverse NHS trusts. Successful implementation into complex healthcare settings relies on individual and organisational factors. NoMAD is a theory-based validated research instrument used to measure implementation processes of complex interventions into the healthcare setting, from the perspective of those directly involved.

Staff engagement is key to implementing change, especially for tracheostomy care, where leaders influence multidisciplinary teams from different specialties and sites. Improving Tracheostomy Care Quality Improvement program guided 20 diverse UK sites in implementing the resources of the Global Tracheostomy (QI) Collaborative. The NoMAD instrument is a theorybased validated research instrument that measures implementation processes from the perspective of professionals directly involved in implementing complex healthcare interventions.

Patients with tracheostomies require multidisciplinary care in complex environments from multiple healthcare professionals. This can lead to delays and frustration for the patient and their family, compounded if systems are inconsistent, uncoordinated or ineffective. Improving Tracheostomy Care (ITC) is a three-year Quality Improvement (QI) programme guiding the implementation of the Global Tracheostomy Collaborative’s (GTC) resources into 20 diverse UK sites. HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is a patient satisfaction survey required for all hospitals in the United States providing Medicaid services and for the NHS Patient Experience Framework. We aimed to evaluate the impact of the ITC program on patient satisfaction using HCAHPS.

Patients with tracheostomies and their families can experience delays and frustration with care, compounded if systems are inconsistent, uncoordinated or ineffective. Improving Tracheostomy Care (ITC) is a three-year Quality Improvement (QI) programme guiding the implementation of the Global Tracheostomy Collaborative’s (GTC) resources into 20 diverse UK sites to address patient satisfaction. HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is a patient satisfaction survey used in both the United States and the NHS to describe the patient experience. The aim of this study was to evaluate the internal consistency (reliability) of HCAHPS in this setting.

Improving Tracheostomy Care (ITC) is a three-year Quality Improvement (QI) programme guiding the implementation of the Global Tracheostomy Collaborative’s (GTC) resources into 20 diverse UK sites. QI is required to address the concerns of patients who experience variable or inconsistent standards of care, resulting in dissatisfaction. HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is a patient satisfaction survey required for all hospitals in the United States providing Medicaid services and for the UK NHS Patient Experience Framework. We aimed to evaluate the variability in satisfaction between participating sites using HCAHPS, and the impact of the QI project on such variability.

In 2004, a multidisciplinary team (MDT) tracheostomy care model was developed to care for patients with a tracheostomy who were outside of the intensive care setting. The three main components of the MDT care model are: a tracheostomy care bundle checklist, an educational program for staff on the dedicated wards where patients with a tracheostomy are cared for and a dedicated MDT who attend a weekly tracheostomy ward round. We have critically reviewed how the care model is currently working to reassess its effectiveness. In addition, we have looked at the financial savings brought about by the reduction in length of stay in the high dependency setting.

Factors associated with successful early and late tracheostomy decannulation in adults have not yet been definitively established in the literature. Identification of these factors would enable health care professionals to inform patients of the likely course of care, enable appropriate resource allocation and follow up care using best available evidence, and ascertain targets for intervention. The aim of this study was to identify factors associated with successful early and late tracheostomy decannulation in adult patients in a large metropolitan tertiary acute hospital.

Standardized care provided by a specialized multidisciplinary tracheostomy team is associated with fewer tracheostomy-related complications and improves standard of care.

Globally there are considerable patient safety risks associated with children who have tracheostomies. Within our institution, concerns were noted regarding the risk of serious avoidable tracheostomy morbidity. The Paediatric Working Party of National Tracheostomy Safety Project (NTSP) was established in 2014.

In 1981, a child in the US was discharged home dependent on medical technology. Since then, it is widely acknowledged this cohort of children should live at home. However, most countries are still reactive in their approach to care. The aim of this study was to explore knowledge and challenges caring for children technology dependent in the home care setting. Knowledge was specifically asked in relation to best practice caring for a child / young person requiring tracheostomy care and challenges nurses’ face caring for this cohort of children in the homecare setting.

The Global Tracheostomy Collaborative (GTC) is a Quality Improvement (QI) collaborative conceived to help healthcare providers improve the care they deliver. Inadequate care can leave patients feeling anxious, and the potentially life-threatening or life-changing experiences associated with tracheostomy can lead to depression. The Improving Tracheostomy Care (ITC) program has implemented the GTC resources into 20 diverse UK NHS hospitals. The aim of this project was to evaluate the impact of the ITC program on patient anxiety and depression, assessed using the Hospital Anxiety and Depression Scale (HADS).

A multidisciplinary Tracheostomy Management Service (TMS) was implemented at the Royal Brisbane and Women’s Hospital (RBWH) as an Intensive Care Outreach Service to provide expert consultation to support wards managing patients with a tracheostomy. Consumers and clinicians were identified as key stakeholders from the outset to inform service implementation and development of procedural resources and educational frameworks. The aim was to partner with consumers and clinicians to better understand their concerns and improve the journey for the patient with a tracheostomy in the RBWH.

Tracheostomy care is an important priority for many health care systems. We identified a lack of clinical ownership for non-cancer head and neck community tracheostomy patients. An application to NHS England led to a project to study the potential role of a TCP for non-cancer head and neck. The aims were (1) improve patient safety (2) reduce number of admissions and length of stay (3) identify patients suitable for decannulation.

Tracheostomy related emergencies, require timely management and remain a significant cause for morbidity and mortality necessitating competency training for providers. Our aim was to enhance resident self-efficacy (SE), knowledge and skills with tracheostomy management utilizing an effective curriculum.

Recommendations for the safe care of patients with altered airways are made by “On the Right Trach” (NCEPOD) and the NTSP. An Interprofessional Tracheostomy Safety Training Day has been run at Fiona Stanley Hospital since 2015. The course provides a combination of lectures, hands-on equipment familiarisation, high-fidelity simulation and debriefing to teach participants about routine and emergency care of patients with tracheostomy and laryngectomy.

Austin Health, The Global Tracheostomy Collaborative (GTC) and the Royal Children’s Hospital hosted the 5th International Tracheostomy Symposium (ITS) on October 11, 2019 in Melbourne, Australia. Since the inaugural ITS in 2011 in Melbourne the ITS has grown to become the premier event in tracheostomy care worldwide.

Four UK NHS hospitals joined the Global Tracheostomy Collaborative, implemented changes to practice and achieved reductions in median length of hospital stay. These reductions crudely translate to cost savings, which we have used to produce cash releasing models for various sizes of hospital.

The care of tracheostomy patients is complex, requiring expertise from professionals across specialties for optimal management of airway, communication, and nursing needs. This systematic review of the literature and meta-analysis aims to assess whether multidisciplinary teams for tracheostomy management, compared to usual care, improve outcomes for patients with tracheostomies.

Above Cuff Vocalisation involves passing retrograde gas flow via the subglottic suction port of standard tracheostomy tubes. We studied in detail the effectiveness and adverse effects of this underutilised technique in ten ventilator dependant critically ill patients.

The 2014 NCEPOD report illustrated a complication rate of 25.2% in a study of over 2,500 tracheostomy patients. Good quality care requires a team-based integrated practice from multiple healthcare professionals. The benefits of medical teaching using webinar software are becoming increasingly realised. Webinars are an accessible tool and are therefore uniquely placed to deliver interprofessional education.

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