TRACHEOSTOMY TRAINING AND TROUBLESHOOTING: A PANDEMIC EDUCATIONAL EFFORT

Abstract

TOPIC: Education, Research, and Quality Improvement TYPE: Original Investigations PURPOSE: The unprecedented COVID 19 pandemic has contributed to an increase in patients with respiratory failure many of which are requiring tracheostomy. As a result, the need for a working knowledge of tracheostomy care by many levels of care providers has soared. There are short and long term complications associated with tracheostomies. Multi-disciplinary team training for tracheostomy care may improve the care of these patients. METHODS: Medicine residents were given a pre-survey questionnaire to test their baseline knowledge on tracheostomies, understanding of available resources and comfort levels with dealing with day to day care and emergencies. Afterwards, a pre-test was given on knowledge about tracheostomies and daily/emergency management. Subsequently, they were given an educational presentation on tracheostomy selection, special COVID considerations, daily care and emergency troubleshooting. After completion of the education portion, residents underwent simulation lab training, comprising 4 stations: basic care;bleeding tracheostomy;accidental decannulation and tracheostomy obstruction. Residents were then re-tested to assess improvement in knowledge with plans to re-test in 6 months to monitor retention. RESULTS: Pre/Post survey results showed improvement in questions related to which service to call if there is a tracheostomy issue (69.9% to 92.3%), how to find tracheostomy specifics in the electronic medical record (13% to 61.5%), usefulness of a tracheostomy chart above the head of the bed (95.6% to 100%) and if tracheostomy emergency kits in each room were useful (91% to 100%). Pre/Post testing on the didactic and hands-on curriculum were administered. The pre-test results, no one passed as scores ranged 34-68 % out of a possible score of 100%. Post-test, everyone improved their scores with 75 % of learners passing the post test exam scoring 85-100%. Average test scores prior to lecture and simulation lab was 44%, compared to post test average of 83%. CONCLUSIONS: Residents increased their knowledge and awareness about tracheostomies as seen through improvements in all categories within testing. Residents favored specific educational scenarios about tracheostomy emergencies to delineate team training, roles and algorithms for care and in person training over online modules. This curriculum on tracheostomy troubleshooting and care can be operationalized for a wide array of team based multi-disciplinary providers throughout the spectrum of care. CLINICAL IMPLICATIONS: Standardized curriculum with clear objectives coupled with hands-on team training along with pre and post knowledge assessments can be readily implemented during a global pandemic. Further follow up assessments will be needed to determine if long term knowledge retention translates to sustained bedside benefit. DISCLOSURES: No relevant relationships by Alissa Ali, source=Web Response No relevant relationships by Doreen Kane, source=Web Response No relevant relationships by Louise Kane, source=Web Response Consultant relationship with Veracyte Please note: 2019-2021 Added 06/23/2021 by Carla Lamb, source=Web Response, value=Honoraria No relevant relationships by Tania Mangahas, source=Web Response No relevant relationships by Ekaterina Yavarovich, source=Web Response