Tracheostomy Care Education for the Nonsurgical First Responder: A Needs-Based Assessment and Quality Improvement Initiative.

Abstract

ObjectivesTo perform a needs-based assessment for tracheostomy care education for nonsurgical first responders in the hospital setting and to implement and assess the efficacy of a targeted tracheostomy educational program.MethodsA prospective observational study conducted between October 2017 and May 2018 including emergency medicine (EM) residents, internal medicine (IM) residents, and intensive care unit (ICU) advanced practice providers at 2 tertiary hospitals. Needs-based assessments were conducted, leading to specialty specific curricula. One-hour educational sessions included didactics and case-based simulation. A pre- and posttest objective knowledge quiz and self-assessment were administered, and a posttest was repeated at 6 months.ResultsThere were 85 participants (13 ICU, 40 EM, 32 IM). Significant improvement (P < .05) in mean objective knowledge score was seen across all groups between pre- and postintervention assessments with relative but not significant improvement at 6 months. There were significant increases in comfort level from pre- to postintervention. At 6-month follow-up, comfort level remained significantly increased for the majority of questions for the EM group and for select questions for IM and ICU advanced practice provider groups.DiscussionNonsurgeons are often first responders to critical airway situations yet receive limited formal education regarding tracheostomy. We demonstrated improvement in knowledge and comfort after a targeted educational module for tracheostomy care and management.Implications for PracticeAlthough tracheostomy care is multidisciplinary, specialty-specific education may provide a more relevant foundation on which to build skills. Prompt and effective management of tracheostomy emergencies by first responders may improve patient safety and reduce mortality.