Using Didactics and Simulation to Enhance Comfort, Knowledge, and Skills of Nonsurgical Trainees Caring for Patients With Tracheostomy and Laryngectomy

Abstract

Introduction Management of tracheostomy and laryngectomy is an important skill for physicians who often care for patients with multiple, comorbid, chronic medical conditions. There is little published literature on training for tracheostomy and laryngectomy care during nonsurgical specialty residencies. This project was designed to assess and improve comfort with, knowledge of, proficiency in tracheostomy and laryngectomy care. Methods This prospective observational study comprised 122 physician trainees from internal medicine, emergency medicine, and anesthesia training programs at the University of Arkansas for Medical Sciences participating in a simulation-based curriculum from April 2016 to December 2016. The curriculum included didactic session, hands-on experience performing a tracheostomy change, and practicing emergency scenarios on interactive, high-fidelity simulation mannequins. Preintervention and postintervention assessments of self-perceived comfort, objective knowledge, and tracheostomy change proficiency were performed and results compared. Results Self-perceived comfort improved from a mean Likert score from 2.12 to 4.43 (P = 0.009). Knowledge mean scores improved from 57% to 82% (P < 0.001) on multiple-choice testing. Tracheostomy change proficiency mean scores improved from 41% to 84% (P < 0.001) of proficiencies correctly performed. Six-month follow-up assessment of comfort and knowledge showed statistically significant retention of comfort (P = 0.002) and knowledge (P = 0.026). Conclusions Comprehensive tracheostomy and laryngectomy education, which combines enhancement of knowledge with simulation of both routine and emergent aspects of care, is an effective strategy in improving confidence with, knowledge of, proficiency in tracheostomy and laryngectomy care. Retention of confidence and knowledge was demonstrated 6 months later.

Impact of COVID-19 on carers of children with tracheostomies

“…Nevertheless, in line with existing qualitative evidence describing how the lives of these families can be ‘highly complicated and frequently overwhelming’24 and the associated psychological burden and daily struggle,8 9 the pandemic was not always seen to be the most significant challenge they faced. The difficulties associated with knowledge and confidence in delivering tracheostomy care,1 5 25–27 adapting to the transition from hospital to home and coping with the responsibilities of medical care, disrupted lives3 28 and dealing with care coordination9 has also been highlighted by others. Narratives from parents and health professionals demonstrated rapid adaptation, normalisation and varying degrees of stoicism and citizenship around constantly changing pandemic-related requirements.…”

Postoperative Management After Tracheostomy and Laryngectomy: Improving Nursing Knowledge With Bedside Posters

“…Other institutions have attempted similar interventions to improve their nursing teams’ confidence in managing these complicated airways. However, their interventions (training sessions, online modules, high‐fidelity mannequins) required significant time and resources, which can be potential barriers for sustainable improvements 4–6 . Our study offered a brief intervention that is easily implemented with negligible cost.…”

“…However, their interventions (training sessions, online modules, high-fidelity mannequins) required significant time and resources, which can be potential barriers for sustainable improvements. [4][5][6] Our study offered a brief intervention that is easily implemented with negligible cost. This lends itself to future studies that may assess the sustained efficacy of this intervention.…”

“…Attempts to address these concerns include the use of didactic sessions, simulations, and mandatory signage near patient beds. 4,6 These have been shown to be a simple, cost-effective intervention to improve knowledge of health care professionals. The purpose of this study was to determine whether a didactic session and informational posters confer improvement in knowledge of surgically altered airways (tracheostomy and laryngectomy) among nursing staff.…”

“…Attempts to address these concerns include the use of didactic sessions, simulations, and mandatory signage near patient beds 4,6 . These have been shown to be a simple, cost‐effective intervention to improve knowledge of health care professionals.…”