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Five Drivers for Tracheostomy Quality Improvement

How Data-Driven Multidisciplinary Trach Teams Transform Care, Prevent Harm, and Save Lives

On-Demand Session


Tracheostomy incidences in ICUs account for up to one half of all airway-related deaths and hypoxic brain damage, according to Brandon S. Hopkins, MD, of Cleveland Clinic in Shaker Heights, Ohio. “Despite this, tracheostomy is a necessary and routine procedure in many of our hospitals. It’s also one of the least standardized with regard to management and care,” he said.

Vinciya Pandian, PhD, MBA, MSN, RN, ACNP-BC, FAANP, FAAN

In an effort to improve the quality of tracheostomies across the board, panelist Vinciya Pandian, PhD, MBA, MSN, RN, ACNP-BC, of Johns Hopkins University School of Nursing, shared five ways to make sure your institution is doing all it can to achieve best practices. If it hasn’t already, consider making plans for your hospital system to implement:

1. Multidisciplinary team-based care. Replace siloed care with multi-disciplinary team-based care, said Dr. Pandian. This should include all physicians, nurses, respiratory therapist, and speech-language pathologists involved in the treatment of the patient.

2. Standardization of care. This is not only a problem from hospital to hospital, said Dr. Pandian. Hospitals need to make sure everyone in their own facility is providing the same standardized treatment to patients. Johns Hopkins in particular has a set of standardized protocols that detail the role of every single player involved in scenarios from transporting a patient with a tracheostomy to capping decannulation.

3. Broad staff education. A lot of times a physician does not learn how to care for tracheostomy patients until they arrive in the clinical setting. Do not count on a medical school having taught the physician what to do—and certainly don’t count on them having been taught the specific hospital’s protocols. The institution should be implementing regular staff training.

4. Patient and family involvement. “There is increased recognition worldwide that patients and families are essential allies for quality and safety,” said Dr. Pandian. “The Global Tracheostomy Collaborative has also found this to be true in many of their member hospitals.” Remember to include them in every aspect of treatment, from direct care interactions to policy development.

5. Patient-level data. Using data to drive quality improvement allows you to see where your multidisciplinary team is effective and efficient and where it could use some more work.

“Until five or 10 years ago, I think we would present these cases at our morbidity and mortality conferences, and I think we would acknowledge the difficulty of them with regret, but we didn’t really have a way forward,” said Michael J. Brenner, MD, a panelist from the University of Michigan School of Medicine and president of the Global Tracheostomy Collaborative. “And now we do. I think that while it may be a long trip to zero harm, we can be purposeful and deliberate by implementing the five drivers that Vinciya and actually all of [the panelists] have spoken to really more eloquently than I can. I think the real strength of the Global Tracheostomy Collaborative is that it makes you part of a community so that you really have a group of peers that you can talk to, and it provides a structure. The database allows you to track your progress so that you’re not just looking at how you’re doing, but you’re looking at how you can do better.”

This Panel Presentation was presented live on Monday, September 14, 2:00 – 3:00 pm (ET) but is now available in the on-demand library of education content.