Interprofessional Tracheostomy Care: Resuming and Redefining Best Practice

PROGRAM DESCRIPTION: Tracheostomy-related incidents account for up to half of all airway-related deaths and hypoxic brain damage in intensive care settings. Interprofessional adult and pediatric tracheostomy teams have achieved dramatic reductions in adverse events and improved patient outcomes, but dissemination of highly reliable practices has lagged. In the wake of the COVID-19 pandemic and ongoing viral surges, hospital systems have been forced to reevaluate and reinterpret tracheostomy workflows over the last 3 years. Staffing shortages have forced us to streamline care, post-tracheostomy patients continue to report to tertiary centers with airway stenosis, and patient and provider safety when managing these patients has continued to challenge systems. This panel provides strategies for rapid performance optimization and building blocks for enhancing care. Five key drivers- interprofessional ward rounds, standardized protocols, interdisciplinary education and staff allocation, patient and family involvement, and using data to drive improvement – can result in transformative change. We present data across institutions and aim to provide easily actionable solutions to common problems. We cover care from the index procedure to decannulation and discharge, discussing obstacles encountered and how they are overcome. Alongside institution-level experience, we report the largest structured tracheostomy practice improvement project to date, reflecting prospectively captured data from over 11,000 cases. We report multicenter efforts involving mixed method analysis, data tracking, and benchmarking to demonstrate statistically significant effects on reducing hospital and ICU length of stay, ventilator duration, and time to cuff deflation, oral intake, first vocalization with dramatic cost savings, and provider knowledge in systems who have adopted interprofessional tracheostomy methods. Collectively, these data provide a direction forward for interprofessional tracheostomy care in the new healthcare environment of staffing shortages and waves of viral infections.

OUTCOME OBJECTIVE 1: To present building blocks and obstacles to creating a interprofessional tracheostomy care team

OUTCOME OBJECTIVE 2: To compare the approaches of different hospital systems in the creation of tracheostomy care teams and address new demands during waves of viral illness

OUTCOME OBJECTIVE 3: To leverage data-science and ongoing efforts to improve tracheostomy outcome

BACKGROUND STATEMENT: Each panelist has experience instituting and maintaining interprofessional tracheostomy teams. These teams have been shown to greatly improve patient outcomes. It is important to share our experience and provide tools and data to support similar efforts at other institutions.