Role of the multidisciplinary team in the care of the tracheostomy patient

Bonvento, Barbara; Wallace, Sarah; Lynch, James C.; Coe, Barry; McGrath, Brendan A.

doi:10.2147/jmdh.s118419

Cited by 87 publications

(58 citation statements)

References 70 publications

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“…[1][2][3][4] One must rapidly recognize and appropriately intervene when airway-related complications occur to provide safe care and prevent harm. 2,7,8 Regardless of the etiology of an acute decompensation event in the tracheostomy-dependent child, primary management consists of establishing a patent airway by suctioning and/or replacing the tracheostomy tube. 8 Many centers, including ours, have patients with tracheostomy and ventilator requirements on the pediatric wards where residents provide care.…”

Section: Introductionmentioning

confidence: 99%

“…7,11 Therefore, resident physicians tasked with caring for patients with tracheostomy and ventilator requirements require specialized training to safely and confidently perform the appropriate steps for tracheostomy tube suctioning and replacement. 7,[11][12][13] Simulations have long been shown to provide a safe space for learners to practice unfamiliar skills. 14 Simulation has been used in the tracheostomy patient population to create realistic clinical scenarios that allow learners to seek feedback, reflect, and learn with no risk to the patient.…”

Section: Introductionmentioning

confidence: 99%

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“When in Doubt, Change It out”: A Case-Based Simulation for Pediatric Residents Caring for Hospitalized Tracheostomy-Dependent Children

et al. 2020

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Introduction: Caring for technology-dependent children, such as those with tracheostomy and ventilator dependence, can be new and frightening for pediatric residents. Education about emergencies in this patient population is important because these children are at risk for in-hospital complications. Safe care of the tracheostomy-dependent child requires the ability to recognize common complications, such as tracheostomy tube obstruction or decannulation, and intervene appropriately by suctioning and/or replacing the tracheostomy tube. This simulation-based curriculum teaches learners to identify and practice the management of these tracheostomy tube complications through low-fidelity simulation exercises. Methods: We created a simulation session with three cases reflecting in-hospital scenarios encountered by resident physicians caring for tracheostomy-dependent children in the inpatient setting. The simulation scenario, simulation environment preparation, materials list, and debriefing outline are provided for the instructor for each simulation case. Validity evidence for the assessment tool was obtained by calculating the interrater reliability of two different raters. Resident feedback was obtained through anonymous surveys. Results: Twelve pediatric senior residents completed the experience. It received overwhelmingly positive feedback on learner evaluation forms, with 90% finding the experience very or extremely helpful. The intraclass correlation coefficient of interrater reliability for our assessment tool was 0.93. Discussion: The simulation was well received by residents. The interrater reliability was acceptable. This low-fidelity simulation exercise can easily be executed with minimal materials or instructor training. High-yield, just-in-time training with postcase debriefing is key to the simulation's success.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“When in Doubt, Change It out”: A Case-Based Simulation for Pediatric Residents Caring for Hospitalized Tracheostomy-Dependent Children

et al. 2020

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“…These complications demands a multidisciplinary team approach, with good coordination between its team members, for evaluation and rehabilitation to ensure the safety and quality care of these patients. 10,11 In a study, Mah et al concluded that, "the introduction of care bundle for post tracheostomy care to the multidisciplinary tracheostomy service significantly improve oral diet intake as well as decannulation". 12 Thus restoration of function of respiration, phonation, feeding and swallowing demands a strict integration and participation among different members of the multidisciplinary rehabilitation team.…”

Section: Discussionmentioning

confidence: 99%

Swallowing Difficulties with Tracheostomy: A Neuro-Rehabilitation Perspective

Saqulain

Mumtaz

2020

JIMDC

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Swallowing and breathing are complex and highly coordinated functions. These functions depend on well-coordinated work of many organs with larynx and nervous system playing a critical role. Disturbance in one of these functions negatively affects the other. Surgical airways like tracheostomies are required in a number of situations, including but not limited to major head and neck procedures, cases with decreased lung function, excessive bronchial secretions and cases requiring neuro-rehabilitation when prolonged airway is required for mechanical ventilation. Extensive neuro-rehabilitation is required since patients with surgical airway may develop swallowing difficulties including dysphagia and/or aspiration with a very high prevalence, which can pose a threat to life. This article reviews the current status of the diagnostic and therapeutic modalities for swallowing difficulties with special emphasis on current neuro-rehabilitative strategies. Electronic databases including Medline, Web-of-science, Cochrane Library, and Google scholar were used for literature search. Downloaded articles were subsequently assessed independently by two researchers to determine suitability for inclusion in the study.Key words: Neurorehabilitation, Tracheostomy, Transcranial direct current stimulation, Transcranial magnetic stimulation, swallowing difficulty

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“…Decreasing inpatient tracheostomy‐related complications requires institution‐wide protocols for tracheostomy care, implementing simple preventative and rescue measures, and ensuring that staff trained in rescue measures are available at the bedside within minutes of an emergency to intervene before permanent hypoxic injury occurs. Coordinated multidisciplinary teams and protocol‐driven, institution‐wide efforts involving all providers involved in tracheostomy care drastically reduces tracheostomy‐related catastrophic events and mortality. Institutional tracheostomy care improvement efforts in the United Kingdom and Australia reduced tracheostomy‐related adverse events by over 90%, with similar success replicated in the United States .…”

Section: Discussionmentioning

confidence: 99%

Mortality associated with tracheostomy complications in the United States: 2007–2016

2018

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Objectives/Hypothesis To investigate patterns of tracheostomy‐associated death in the United States. Study Design Retrospective database review. Methods We used Multiple Cause‐of‐Death data from the Centers for Disease Control and Prevention to determine cumulative national mortality associated with tracheostomy complications in the United States from 2007 to 2016. Using International Classification of Diseases, Tenth Revision data, we investigated how frequently tracheostomy‐related complications were reported in cause of death data. We then compared the characteristics of patients with tracheostomy‐related mortality to patients reported to have died of other causes. Results Over the 10‐year period studied, we identified 623 tracheostomy‐related deaths (537 adults and 86 children) out of 25,587,306 total deaths reported. Although absolute mortality was higher in adults, the reported base rate of tracheostomy complication–associated mortality was tenfold higher in children. Most tracheostomy‐related deaths occurred in a hospital facility (74.5% in adults). Deaths associated with tracheostomy complications were significantly more common for African American children (odds ratio [OR]: 2.02, 95% confidence interval [CI]: 1.26‐3.24) and adults (OR: 1.59, 95% CI: 1.29‐1.96) or in Hispanic adults (OR: 1.42, 95% CI: 1.06‐1.89). Deaths related to a tracheostomy complication more commonly occurred on the weekend (OR: 1.24, 95% CI: 1.04‐1.49) and in the most recent 2‐year period (OR: 1.31, 95% CI: 1.03‐1.68). Adults with a bachelor's, master's or doctorate degree were significantly less likely to have mortality associated with a tracheostomy‐related complication (OR: 0.54, 95% CI: 0.39‐0.75). Conclusions Tracheostomy‐related complications were implicated in the deaths of a significant number of individuals. Several demographic groups had increased likelihood of tracheostomy‐related mortality. Future research is necessary to develop targeted interventions to decrease harm. Level of Evidence NA Laryngoscope, 129:619–626, 2019

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Role of the multidisciplinary team in the care of the tracheostomy patient

Cited by 87 publications

References 70 publications

“When in Doubt, Change It out”: A Case-Based Simulation for Pediatric Residents Caring for Hospitalized Tracheostomy-Dependent Children

“When in Doubt, Change It out”: A Case-Based Simulation for Pediatric Residents Caring for Hospitalized Tracheostomy-Dependent Children

Swallowing Difficulties with Tracheostomy: A Neuro-Rehabilitation Perspective

Mortality associated with tracheostomy complications in the United States: 2007–2016

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