Samuel J Rubin1, Stefanie S Saunders2, Jacob Kuperstock3, Dominick Gadaleta2, Peter A Burke4, Gregory Grillone5, James M Moses6, Jaime P Murphy7, Gerardo Rodriguez8, Andrew Salama9, Michael P Platt10. 1. Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, MA, USA. Electronic address: Samuel.rubin@bmc.org. 2. Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, MA, USA. 3. Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, MA, USA. Electronic address: Jacob.kuperstock@bmc.org. 4. Department of General Surgery, Section of Trauma and Acute Care Surgery, Boston University School of Medicine, Boston, MA, USA. Electronic address: Peter.Burke@bmc.org. 5. Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, MA, USA. Electronic address: Gregory.grillone@bmc.org. 6. Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA. Electronic address: James.Moses@bmc.org. 7. Department of Pulmonary Medicine, Critical Care and Allergy, Boston University School of Medicine, Boston, MA, USA. Electronic address: James.Murphy@bmc.org. 8. Department of Anesthesiology, Boston University School of Medicine, Boston, MA, USA. Electronic address: Gerardo.Rodriguez@bmc.org. 9. Department of Oral & Maxillofacial Surgery, Henry M. Goldman School of Dental Medicine, Boston, MA, USA. Electronic address: Andrew.salama@bmc.org. 10. Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, MA, USA. Electronic address: miplatt@bu.edu.
Abstract
PURPOSE: Develop a model for quality improvement in tracheostomy care and decrease tracheostomy-related complications. METHODS: This study was a prospective quality improvement project at an academic tertiary care hospital. A multidisciplinary team was assembled to create institutional guidelines for clinical care during the pre-operative, intra-operative, and post-operative periods. Baseline data was compiled by retrospective chart review of 160 patients, and prospective tracking of select points over 8 months in 73 patients allowed for analysis of complications and clinical parameters. RESULTS: Implementation of a quality improvement team was successful in creating guidelines, setting baseline parameters, and tracking data with run charts. Comparison of pre- and post-guideline data showed a trend toward decreased rate of major complications from 4.38% to 2.74% (p = 0.096). Variables including time to tracheotomy for prolonged intubation, surgical technique, day of first tracheostomy tube change, and specialty performing surgery did not show increased risk of complications. There were increased tracheostomy-related complications in cold months (p = 0.04). CONCLUSIONS: An interdisciplinary quality improvement team can improve tracheostomy care by identifying system factors, standardizing care among specialties, and providing continuous monitoring of select data points.
PURPOSE: Develop a model for quality improvement in tracheostomy care and decrease tracheostomy-related complications. METHODS: This study was a prospective quality improvement project at an academic tertiary care hospital. A multidisciplinary team was assembled to create institutional guidelines for clinical care during the pre-operative, intra-operative, and post-operative periods. Baseline data was compiled by retrospective chart review of 160 patients, and prospective tracking of select points over 8 months in 73 patients allowed for analysis of complications and clinical parameters. RESULTS: Implementation of a quality improvement team was successful in creating guidelines, setting baseline parameters, and tracking data with run charts. Comparison of pre- and post-guideline data showed a trend toward decreased rate of major complications from 4.38% to 2.74% (p = 0.096). Variables including time to tracheotomy for prolonged intubation, surgical technique, day of first tracheostomy tube change, and specialty performing surgery did not show increased risk of complications. There were increased tracheostomy-related complications in cold months (p = 0.04). CONCLUSIONS: An interdisciplinary quality improvement team can improve tracheostomy care by identifying system factors, standardizing care among specialties, and providing continuous monitoring of select data points.