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Title: Improving tracheostomy care in the United Kingdom: results of a guided quality improvement programme in 20 diverse hospitals.
Austin Authors: McGrath, Brendan A;Wallace, Sarah;Lynch, James;Bonvento, Barbara;Coe, Barry;Owen, Anna;Firn, Mike;Brenner, Michael J;Edwards, Elizabeth;Finch, Tracy L;Cameron, Tanis S ;Narula, Antony;Roberson, David W
Affiliation: Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
Tracheostomy Review and Management Service (TRAMS), Austin Health, Heidelberg, Victoria, Australia
Manchester University NHS Foundation Trust, Manchester, UK
South West London and St George's Mental Health NHS Trust, Tooting, London, UK
University of Michigan, Ann Arbor, MI, USA
Patient Champion, Manchester, UK
Department of Nursing, Midwifery and Health, University of Northumberland, Newcastle Tyne, UK
Imperial Healthcare, London, UK
Bayhealth Medical Group, Milford, DE, USA
Issue Date: Jul-2020 2020-05-31
Publication information: British journal of anaesthesia 2020; 125(1):e119-e129
Abstract: Inconsistent and poorly coordinated systems of tracheostomy care commonly result in frustrations, delays, and harm. Quality improvement strategies described by exemplar hospitals of the Global Tracheostomy Collaborative have potential to mitigate such problems. This 3 yr guided implementation programme investigated interventions designed to improve the quality and safety of tracheostomy care. The programme management team guided the implementation of 18 interventions over three phases (baseline/implementation/evaluation). Mixed-methods interviews, focus groups, and Hospital Anxiety and Depression Scale questionnaires defined outcome measures, with patient-level databases tracking and benchmarking process metrics. Appreciative inquiry, interviews, and Normalisation Measure Development questionnaires explored change barriers and enablers. All sites implemented at least 16/18 interventions, with the magnitude of some improvements linked to staff engagement (1536 questionnaires from 1019 staff), and 2405 admissions (1868 ICU/high-dependency unit; 7.3% children) were prospectively captured. Median stay was 50 hospital days, 23 ICU days, and 28 tracheostomy days. Incident severity score reduced significantly (n=606; P<0.01). There were significant reductions in ICU (-;0.25 days month-1), ventilator (-;0.11 days month-1), tracheostomy (-;0.35 days month-1), and hospital (-;0.78 days month-1) days (all P<0.01). Time to first vocalisation and first oral intake both decreased by 7 days (n=733; P<0.01). Anxiety decreased by 44% (from 35.9% to 20.0%), and depression decreased by 55% (from 38.7% to 18.3%) (n=385; both P<0.01). Independent economic analysis demonstrated £33 251 savings per patient, with projected annual UK National Health Service savings of £275 million. This guided improvement programme for tracheostomy patients significantly improved the quality and safety of care, contributing rich qualitative improvement data. Patient-centred outcomes were improved along with significant efficiency and cost savings across diverse UK hospitals. IRAS-ID-206955; REC-Ref-16/LO/1196; NIHR Portfolio CPMS ID 31544.
DOI: 10.1016/j.bja.2020.04.064
PubMed URL: 32493580
Type: Journal Article
Subjects: Global Tracheostomy Collaborative
airway management
quality improvement
Appears in Collections:Journal articles

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