1. 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

2. 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):
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):  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.

3. 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.

4. 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)

5. 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

6. 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