The 3rd International Tracheostomy Symposium (ITS) was an astounding success. Thank you to everyone who participated. With over 200 registrants either in person or via live streaming, we found great support for the GTC and a thirst for quality improvement to be put into practice. The major takeaway: healthcare, especially high quality tracheostomy care is a team endeavor. Every team member has different experiences and perspectives, and by working together, we will improve the culture of tracheostomy care in our institutions.
Our goal with this conference was two-fold: (a) to allow care providers of different backgrounds to network and learn from each other, and (b) to demonstrate the value of the Global Tracheostomy Collaborative (GTC) to attendees, some of whom are not yet members.
A great example of the power of coming together was demonstrated on the second day. A “pediatric interest group” spontaneously convened over lunch, and, those involved plan to continue working together.
We hope we have demonstrated the value and importance of joining the GTC. Certainly patients with tracheostomies are some of the most complex patients that we manage in healthcare, and learning from leading organizations around the world has tremendous potential to improve the lives of these patients and their families.
If your organization would like to join us, please contact us at firstname.lastname@example.org
David Roberson, MD
Events and presentations – a summary
Day 1: April 29, 2016
Day 1 Morning Session
Michael Brenner MD, FACS outlined the importance of a quality improvement collaborative and the role of multidisciplinary care. Additional opening remarks were made by Vinciya Pandian, PhD, MSN, ACNP-BC, Colleen Koch MD, MS, MBA, FACC, Margaret Skinner MD, Charles Cummings MD, Albert Chi MD, and Robert Higgins MD.
David Roberson MD, FACS, FRCS gave an introduction into the Global Tracheostomy Collaborative, highlighting the work we do to make sure that each hospital performs at its highest potential for care. The GTC allows hospitals to benchmark their success against other member hospitals using biannual reports. With more members and more patient data, reports will be more statistically significant and thereby more useful. Just as important, members of the collaborative can learn from each other, thereby improving their care processes. Defining the scope of the problem is the first step in improving a hospital's tracheostomy care.
The keynote speaker was Todd Dorman MD, FCCM. He spoke about the impact of similar collaborative efforts (e.g. the central line bundle), quality improvement initiatives and bundles. When it comes to improving patient care, he recommended reaching out to colleagues with questions and utilizing all available resources. The procedure can be performed by any number of departments, but when a hospital is a part of a collaborative, there is more of a focus on developing protocols and standards that can improve outcomes.
International Perspectives on Tracheostomy Care
Delegates heard from international experts in tracheostomy care from Drs Brendan McGrath, Asit Arora, Stephen Warrillow and Tanis Cameron. Dr McGrath outlined the experience from the UK and described the findings from the National Confidential Enquiry into Patient Outcome and Death (NCEPOD), which reviewed the care of all patients who had a tracheostomy inserted during a 3-month period in England, Wales or Ireland. Dr Arora then described the establishment of the tracheostomy team in St Mary’s Hospital in London, which resulted in a significant reduction in adverse events. This session concluded with Dr Warrillow and Ms Cameron describing tracheostomy care in Australasia and the establishment of the world-leading Tracheostomy Review and Management Service (TRAMS) which has resulted in significant improvements in patient outcomes.
The U.S. Innovations in Tracheostomy Care
Dr. Michael Brenner opened this section of the program by providing an overview of current US tracheostomy experience based on his experiences and recent literature.
Marek Mirski MD, PhD spoke about multidisciplinary team care. Many hospitals have proven that outcomes are improved when representatives from all departments involved in caring for the patient regularly meet. By composing a unified plan of treatment, patients can achieve better outcomes and avoid redundancy in care.
A panel of experts answered questions and spoke on topics in Tracheostomy Care in Diverse Health Systems, and answered from their unique perspectives.
Rahul Shah MD, MBA, outlined the Global Tracheostomy Collaborative’s value proposition. Joining the collaborative gives a hospital access to resources, data, and healthcare professionals who bring many perspectives, with the ultimate goal of improving patient care.
Day 1 Afternoon Session
The afternoon session began with Erin Ward MS.Ed, CAS describing the patient and family perspective. As the mother of a young person with a tracheostomy, she eloquently described what was entailed in caring for a family member with a tracheostomy, emphasizing the importance of quality of life. She also shared the power of partnering with patients and families in quality improvement initiatives to improve tracheostomy care. .
Orenthial J. (O.J.) Brigance shared his journey with ALS, and how he was able to survive with the help of a tracheostomy. He answered questions that the live-streaming audience sent in. His perspective brought to life the reasons the Global Tracheostomy Collaborative is motivated to improve and optimize patient care of those living with tracheostomies.
Concurrent Session A: Patient and Family Session
This session was a huge success, with the room full to capacity with patient families, physicians, nurses, respiratory therapists and speech pathologists – our own Multidisciplinary Team audience! Several patients and family members shared their perspectives, giving examples of how being part of a collaborative increased opportunities to advocate for their own or a loved one’s care, improved communication between healthcare providers and patients/families, and created real improvements in the quality of care. Professionals also shared their experiences partnering with patients and family members in quality improvement initiatives at their institutions, and how their voices can serve as a driving force to positive changes in global tracheostomy care.
Concurrent Session B: Database Session
The database session highlighted the detail that goes into programming a quality-improvement database. The GTC shares its data (aggregated to protect patient privacy) to provide benchmarks for member hospitals. With the strength of data from so many hospitals, the GTC is able to illustrate certain variables that have never been calculated before.
Group 1 was a panel discussion about how healthcare for tracheostomy patients improves at GTC-member hospitals.
Group 2 was a hands-on practice with the database. Users asked questions of the panelists so that they could experience entering a fictional patient’s information into the database, a process that takes about 15 minutes.
Day 2: April 30, 2016
Track A: Excellence in Tracheostomy Care
In the morning, speakers representing various specialties: anesthesia, nursing, respiratory therapy, speech language pathology, otolaryngology, and critical care medicine covered various procedures, including intubation, extubation, the difference between the types of tracheostomy tubes, the timing of tracheostomies, and managing complications. A panel discussed difficult airways and how protocols that deal with more common types of difficult airways can improve the standard of care.
The afternoon began with a focus on pediatric patients, caring for whom is very different than caring for adults.
Linda Morris PhD, APN, CCNS, FCCM covered getting patients home from the hospital, successful rehab, and the vital task of educating caretakers.
Tanis Cameron MA-SLP (C) CCC S-LP, and Kristy McMurray CNC talked about how they care for their patients in Australia with a long-distance program to check on patients. They also detailed how TRAMS (Tracheostomy Review and Management Service) has long-term goals for patient success.
Therese Cole MA, CCC-SLP explained how speech valves can enhance communication for patients. She also reviewed methods to foster communication between patients and their families and care providers. Getting a patient speaking as quickly as possible after a tracheostomy greatly improves quality of life.
Alexander Hillel MD, Vinciya Pandian PhD, MSN, ACNP-BC, and Margaret Skinner MD, discussed tracheostomy de-cannulation and capping.
Adam Schiavi MD, PhD spoke about end-of-life discussions, which can be difficult and challenging decisions for all parties – patient, physician, and family. Respecting patient choices can often be in conflict with ethical decisions.
Track B: Percutaneous Tracheostomy - Didactics
In the morning session, Hans Lee MD talked about patient selection from a proceduralist’s perspective. From the anesthesiology perspective, Christina Miller MD spoke on difficult airway evaluation, comorbidities, hemodynamic stability and psychologic reserve. Ashutosh Sachdeva MBBS covered the PDT Techniques, and Marek Mirski MD, PhD covered bronchoscopic guidance, patient safety and the prevention of loss of airway.
Sherif Afifi MD, FCCM, FCCP, Asit Arora MRCS, DOHNS, Vinciya Pandian PhD, MSN, ACNP-BC, and Alexander Hillel MD, discussed post-operative considerations and care.
Adam Schiavi MD, PhD gave a talk on end of life, quality of life, and ethics.
In the afternoon, a hands-on session covered percutaneous tracheostomy and procedures. A group of surgeons and anesthesiologists taught sessions using human cadavers, mannequins, and pig tissue. Each session covered direct laryngoscopy, videolaryngoscopy, laryngeal mask airway, fiberoptic intubation and percutaneous tracheostomy.
In closing, we would also like to thank the exhibitors who supported us, including Smiths Medical, Neotech, Passy-Muir, Think Dale, Respiralogics, Luminaud and Boston Medical Products whose support was key in making this event a success.
As the summary above outlines, the two-day event was packed with events. We hope we demonstrated the value of teamwork in caring for patients with tracheostomies. Furthermore, a QI collaborative such as the GTC can play a valuable role by providing a mechanism for us to learn best practices and safe care from each other. We encourage your organization to join us.
David Roberson, MD