Improving tracheostomy care: collaborative national consensus and prioritisation of quality improvements in the United Kingdom

BackgroundTracheostomies are artificial airway devices used predominantly to manage airway obstruction and to facilitate weaning from prolonged mechanical ventilation. Whilst a lifesaving procedure, tracheostomy can also lead to significant morbidity and mortality. Associated vocalization and swallowing problems lead to anxiety for patients, families and healthcare staff. The Global Tracheostomy (Quality Improvement) Collaborative can improve the safety and quality of care in participating institutions, leading to a large-scale UK-wide evaluation. However, whilst individual strategies have proved effective in single centres, it is unclear which tracheostomy quality improvement program elements should be prioritized in the UK’s National Health Service’s (NHS) diverse hospitals.AimsThrough a unique consensus and prioritisation exercise using front line staff and leaders from 20 participating UK hospitals, we aimed to develop a national strategy for tracheostomy quality improvements.MethodsFollowing national research ethics committee approval, representative multidisciplinary staff groups were interviewed and completed bespoke questionnaires regarding their experiences of tracheostomy care and associated quality improvements. Qualitative evaluation techniques were applied to develop key themes, further refined by group consensus and prioritisation exercises, creating a ranked list of important quality improvement interventions that should be implemented.Results Thematic analysis yielded 22 statements regarding tracheostomy care. Highly ranked priority interventions included multidisciplinary staff education, standards and competencies, multidisciplinary ward rounds, equipment standardisation and structured care bundles.Conclusion Prioritising distinct quality improvement interventions will allow providers to focus on improving the quality and safety of tracheostomy care using resources and strategies that are important to frontline healthcare staff.