Safe Tracheostomy Care

The outbreak of the COVID-19 pandemic saw Intensive Care Unit (ICU) patients needing a temporary tracheotomy rise by 15-20%.

This increase in demand, coupled with the overall system pressures from the first Coronavirus wave, meant that many of these complex and vulnerable patients would be managed in step-down ICUs or ward areas and cared for by staff who were not familiar with the key principles that can keep them safe.

As part of the Safe Tracheostomy Care (STC) programme Imperial College Health Partners (ICHP) took a unique approach to rapidly and effectively increasing the adoption of three tracheostomy safety interventions into all acute-based tracheostomy care settings, to provide safe and standardised care for all patients.

Background

A national programme to increase tracheostomy safety

Safe Tracheostomy Care (STC) is one of the National Patient Safety Improvement Programmes (NatPatSIP) COVID-19 Response Programmes.

The aim of the STC program is to increase the number of eligible sites adopting three identified tracheostomy safety interventions (bedhead signs along with the emergency care algorithm; ‘bedside’ emergency equipment; daily care bundle) during the COVID-19 pandemic period.

The STC program is based on the methodology and outcomes from a 20-site UK-wide guided implementation program; Improving Tracheostomy Care. This was a national demonstration program, scaled up from a successful four-site pilot in the North West of England, funded by the Health Foundation and delivered in partnership with the Royal college of Anaesthetists, the National Tracheostomy Safety Programme and the Global Tracheostomy Collaborative.

How we helped

A unique approach in NW London

Imperial College Health Partners took a unique approach to program prioritisation and delivery across North West London (NWL), which involved securing buy-in and prioritisation at a regional level via NWL’s Critical Care Network and Gold Command and at a local level via Trust Medical Directors. This approach enabled rapid identification and interest from over 40 multidisciplinary clinicians across seven Trusts, to be part of NWL Safe Tracheostomy Care Collaborative (NWL STCC) which came together in May 2020.

NWL STCC set their goal beyond the aim of the NatPatSIP programme working not only to ensure the three tracheostomy safety interventions were in place across in the relevant settings (ICU, step-down ICU and wards) but to develop resources to sustain and embed good practice across the pathway.

Three priorities were identified for action;

  • Strengthening communication & collaboration across acute & community teams – Coordinated patient centred care
  • Quorate MDT ward rounds (ICU to discharge) – Personalised and whole person approach to care planning and management
  • Training & competency – Strengthen staff capability, confidence & surge planning

Three working groups were set up to design, test out and support adoption of resources, ICHP played a key role in helping to establish new ways of working and steer the delivery of activities that led to the development of a series of resources over a remarkable five month timeframe.

Resources

Resources created to support the programme
  1. Strengthening communication & collaboration across acute & community teams – Coordinated patient centred care
  2. Quorate MDT ward rounds (ICU to discharge) – Personalised and whole person approach to care planning and management
  3. Training & competency – Strengthen staff capability, confidence & surge planning
    • NTSP competency mapping by role
    • NWL Comprehensive Tracheostomy e-training
    • NWL Covid/Surge Tracheostomy e-training
    • Established a NWL safe tracheostomy care collaborative – teams share good practice, expertise & challenges across sites

Testimonial

Having worked on many multidisciplinary cross trust improvement projects previously I was overwhelmed by the enthusiasm and commitment of this team.

“It is an astonishing amount of work to achieve in such a short time and has the potential to have valuable and long-lasting benefits for patients across many trusts.

“The difference here from other projects was partly the timely nature of the issue and the obvious clinical need for these resources which resulted in real commitment and dedication from the team, but also the leadership and direction from ICHP was essential and really helped guide and develop the project and led to its success.”

Susannah Bloch
Respiratory Consultant, Imperial College Healthcare NHS Trust and Chair of NWL STCC

Our Approach and Findings

Strengthening the approach to provision of safe care

There are four key enablers that were fundamental to successful and timely delivery of this remarkable portfolio of work:

  1. Ownership & prioritisation – In the first instance the program secured prioritisation from Trust MDs and NWL Critical care Network which helped to elicit and secure interest from multidisciplinary teams (MDT) across 7 Trusts (12 hospitals). MDTs recognised the added value of this program and embraced the opportunity to locally shape and work on collective priorities that were in needed of improving and important to them.
  2. Hearts & minds – Through active engagement ICHP helped to bring together an enthusiastic and expert group of over 40 clinicians who took on leading roles and committed to delivery across the three workstreams despite tight timescales and juggling other demands and clinical commitments. As a result, new relationships have been fostered across sites which facilitate sharing of good practice and working through joint challenges. Patient perspectives sat at the heart and drove improvements.
  3. Centrally coordinated-locally led model – Improvement initiatives require building in time, clarity and systems to facilitate successful implementation. ICHP played a key stewardship role which helped to centrally support time-pressured clinicians by establishing a streamlined communication pathway, setting up an agile delivery approach, providing clarity on key steps and milestones.  This centrally coordinated-locally led model helped to bring about a structured, engaging, uncomplicated and achievable an approach to improvement.
  4.  Build in sustainability at the start – Embedding good practice into ‘business as usual’ is a key success marker of an improvement program. Sustainability was built in early through Trust ownership of the program, appointing a clinical Chair to lead meetings and multidisciplinary teams taking the lead on all three priorities. Cross-site and MDT approach to collaboration established through NWL STCC will be sustained to keep resources produced up to date, share good practice and identify new priorities for joint action.

As a result, MDTs across NWL Trusts have strengthened their approach to provision of safe, standardised and continuity of care for patients with a tracheostomy and are optimally equipped for a surge response. Learning and resources have secured interest across London and nationally and have been shared via London Transformation and Learning Collaborative and the AHSN network.

It is an outstanding achievement of the NWL STCC to have delivered these priorities during the height of the COVID-19 pandemic. A brilliant piece of work that will benefit patients, staff and the healthcare system.”

Shakti Dookeran
Innovation Lead, Imperial College Healthcare Partners

Contact

If you would like to find out more about this work please email us.