Teaching foundation doctors about tracheostomy management – a six month follow up study AF Cumpstey, E Horwell, S Benham, J Chantler, SR McKechnie John Radcliffe Hospital, University of Oxford, UK

Similar complications also occur after discharge from ICU3 Background Objectives Methods Results Conclusions >50% of patients with a tracheostomy inserted in intensive care (ICU) are discharged before decannulation1 70% of airway-incidents and 60% of airway-related deaths in ICU involve tracheostomy complications2 Similar complications also occur after discharge from ICU3 Lack of training has been identified as a common factor3 1. Martinez GH, Fernandez R, et al. Tracheostomy tube in place at intensive care unit discharge is associated with increased ward mortality. Respir Care. 2009 Dec;54(12):1644-52. 2. Cook TM, Woodall N, Harper J, Benger J, Project FNA. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 2: intensive care and emergency departments. Br J Anaesth. 2011;106(5):632-42. 3. McGrath BA, Thomas AN. Patient safety incidents associated with tracheostomies occurring in hospital wards: a review of reports to the UK National Patient Safety Agency. Postgrad Med J. 2010 Sep;86(1019):522-5.

Objectives Background Methods Results Conclusions Quantify the training junior doctors receive about tracheostomy management. Deliver a focused package of training to junior doctors on the prevention & management of common tracheostomy complications (e.g. tube obstruction, displacement). Assess the subjective effectiveness of this training both immediately & six months later.

New 20 minute session introduced to annual ‘ALERT’ course Methods Background Objectives Results Conclusions New 20 minute session introduced to annual ‘ALERT’ course Classroom based but practically focused Taught by experienced ICU/outreach nurses Topics covered included: Safe tracheostomy configuration for general ward Common complications Simple emergency algorithm Time for further questions 81 new FY1 doctors Online pre-course survey Post course paper survey Normal FY1 ward jobs for six months All invited to complete online survey 83% completion rate (n=67) 100% completion rate (n=81) (New tracheostomy session added) 24% completion rate (n=19)

Results Background Objectives Methods Conclusions 100% found the added tracheostomy session within the ALERT course relevant & useful to their practice 46% of doctors managed ≥ 1 tracheostomy in their first 6/12 on the wards Survey assessment of knowledge of tracheostomy ward settings & emergency management Default Ward Settings Pre-course 6 months % Improvement Inner tube in situ 19.4% 84.2% 64.8 Air Cuff deflated 17.9% 31.6% 13.7 Obstruction Scenario Oxygen to mouth 34.4% 100% 65.6 Oxygen via tracheostomy 57.8% 94.1% 36.3 Remove inner tube 31.3% 82.4% 51.1 Deflate air cuff 20.3% 64.7% 44.4 Call specialist airway support 71.9% 22.2 Overall confidence (score 1-5) 1.6 nil

Conclusions Background Objectives Methods Results Many junior doctors will manage a tracheostomy in their first year on the wards Formal undergraduate teaching in tracheostomy management is uncommon but is judged as both relevant and useful by junior doctors A focused session on tracheostomy management, introduced into an established course on life-threatening events, was effective in improving both confidence and knowledge Sustained improvements in knowledge in tracheostomy management were measurable after 6 months acumpstey@gmail.com