Quality Management Interventions in Tracheotomy: A Retrospective Comparative Study

Area of Science:

• Critical Care Medicine
• Surgical Nursing
• Patient Safety

Background:

• Tracheotomy is a common procedure for patients needing long-term ventilation or neurological care.
• Managing tracheotomized patients presents challenges, with urgent cannula exchanges (CE) posing significant risks.
• Standardized care protocols are crucial for improving safety in tracheotomized patient management.

Purpose of the Study:

• To evaluate the impact of quality improvement measures on complications associated with cannula exchanges in long-term tracheotomized patients.
• To assess the effectiveness of a standardized bedside information sheet and mandatory staff training in reducing CE-related risks.
• To compare complication rates and CE frequency before and after the implementation of new quality measures.

Main Methods:

• A retrospective comparative study design was employed, comparing a pre-intervention cohort with a post-intervention cohort.
• Data were collected through chart reviews of adult tracheotomized patients in a surgical ICU from 2018-2020.
• Cannula exchanges were documented, including indications and complications, followed by descriptive and comparative analyses.

Main Results:

• The post-intervention group showed a decrease in CE frequency (2.65 vs. 4.58 per 100 days) and longer intervals between exchanges (18 vs. 7 days).
• While overall complications and tube occlusions slightly increased in the post-group (8.5% vs. 7.5%), accidental decannulations were marginally lower.
• Respiratory complications decreased, but cardiocirculatory events became more prevalent in the post-intervention group.

Conclusions:

• Managing tracheotomized patients remains complex, requiring continuous quality improvement efforts.
• Standardized information sheets and mandatory staff training may effectively reduce the frequency of cannula exchanges.
• These quality measures appear to enhance patient safety in the management of long-term tracheotomized patients.