ABSTRACT
Introduction: The need for standardised education on tracheostomy care is well recognised.1 Staff frequently report a lack of confidence in caring for those with tracheostomies, as well as the management of adverse events as they occur.2 Over the past decade, healthcare providers have developed strategies to educate staff, however, the covid-19 pandemic has severely hampered the ability to provide this necessary training due to restrictions on access to training rooms, the need for social distancing and the significant clinical demands placed on both trainers and trainees.3 The potential for immersive technologies to augment healthcare training is gaining interest exponentially.4 However, its effectiveness is yet to be clearly understood and as such it is not yet common within healthcare education.5 Based on the above, we aimed to explore the potential of these immersive technologies to overcome the current challenges of tracheostomy education, and to develop future strategies to use immersive technology in healthcare education. Method(s): We received a 400,000 grant from Cardiff Capital Region (CCR) to undertake a rapid innovation project overseen by the SBRI centre of excellence. The project consisted of 3 main phases: 1) feasibility;2) development;and 3) testing. The project was officially launched in April 2021 and lasted 12 months. Project governance was provided via the SBRI for clinical excellence, a project board with representation from Welsh Government, Cardiff University and Cardiff and Vale UHB, and a project team with clinical expertise in both the delivery of tracheostomy education and the provision of simulation training in healthcare. Result(s): Phase 1: During phase one 4 industries were successful and received up to 30,000 to explore the feasibility of immersive technology to support tracheostomy education. The industries were Rescape, TruCorp, Aspire2Be and Nudge Reality. During the feasibility phase all industries focused on the emergency management process utilising existing NHS Wales tracheostomy education resources and the national tracheostomy safety programme. Phase 2: For phase 2, Rescape and Nudge Reality were chosen to develop the technology. These industries continued to work in conjunction with the project team to capture the core elements of tracheostomy care, including multi-user emergency management scenarios. Additional content was also added for bronchoscopy and insertion of intercostal drains. Phase 3: Testing of both solutions was undertaken over an 8-week period, across 6 Health Boards in NHS Wales. The results of the testing will be analysed and available for presentation in due course. Provision findings demonstrate good face and content validity with high levels of user satisfaction. Discussion / Conclusion(s): The provision of essential tracheostomy education has been severely affected by the covid-19 pandemic. Evolving immersive technologies have the potential to overcome these challenges and improve the effectiveness and efficiency of education packages in tracheostomy care and wider. Through this CCR grant, in conjunction with industry, we have developed two solutions with the potential for widescale procurement and future research on the use of immersive technologies within healthcare.
ABSTRACT
Introduction: Prior to the COVID-19 pandemic an estimated 5000 surgical and 12000 percutaneous tracheostomies were completed in the UK each year.1 A UK study looking at COVID-19 tracheostomy outcomes found 1605 tracheostomy cases from 126 hospital, median time from intubation to tracheostomy was 15 days while 285 (18%) patients died following the procedure.2 COVID-19 patients also typically spend longer in critical care with prolonged time receiving organ support when compared to patients diagnosed with other viral pneumonias.3 Incidence of laryngeal pathologies are also higher in COVID-19 patients post tracheostomy.4 Objectives: The aim of this observational study was to review the outcomes of patients post tracheostomy insertion during the COVID-19 pandemic compared to non-COVID patients. Method(s): A service evaluation was completed including all patients requiring a tracheostomy since the beginning of the COVID-19 pandemic in March 2020 within University Hospital Wales, Cardiff. Data was captured from local tracheostomy databases. Patients were grouped into either COVID or non-COVID based on their clinical history. The key outcomes evaluated were number of tracheostomies, average time to cuff deflation and decannulation, critical care and hospital length of stay, occurrence of adverse events and time from critical care admission to tracheostomy insertion. Data was evaluated using descriptive statistics using Microsoft ExcelTM. Result(s): During the review period 58 patients with COVID-19 and 158 without required a tracheostomy. In the COVID-19 group cuff deflation occurred at a median of 10 days post insertion compared to 7 days. Decannulation occurred at a median of 16 days in patients with COVID-19 compared to 18 days. The rate of decannulation was also higher in the COVID-19 group at 74.1% compared to 67.1%. Critical care length of stay was 37 days in the COVID-19 compared to 25 days. Time from intubation to tracheostomy was comparable between groups at a median of 16 days for our COVID-19 cohort compared to 15 days. The incidence of clinical incidents was higher in the non-COVID-19 group at 10.1% compared to 5.2%. Conclusion(s): This internal service evaluation has shown that COVID-19 patients typically spend longer in critical care but their time to decannulation was shorter and their rate of decannulation was higher in our cohort then in the comparison group. This could be due to the tertiary neuroscience and major trauma specialities within our Health Board. Both with groups of patients that, due to the nature of their injuries may require prolonged periods of tracheostomy insertion even after critical care discharge.
ABSTRACT
This chapter discusses the intersection between infectious disease and critical care and how it has impacted the delivery of critical care medicine as well as the ability to provide rehabilitation and psychological intervention. It also considers the psychological implications for critical care staff, relationships at work and team dynamics, and the requirements for staff support. Specific issues encountered during worldwide pandemics are also reviewed, along with implications for future practice. The family of coronavirus illnesses are highlighted, including Middle East respiratory syndrome, severe acute respiratory syndrome, and coronavirus, which causes coronavirus disease (COVID-19). Similarities and differences between practices in the United Kingdom and United States are also discussed. © Oxford University Press 2022. All rights reserved.
ABSTRACT
The COVID-19 pandemic is causing a significant increase in the number of patients requiring relatively prolonged invasive mechanical ventilation and an associated surge in patients who need a tracheostomy to facilitate weaning from respiratory support. In parallel, there has been a global increase in guidance from professional bodies representing staff who care for patients with tracheostomies at different points in their acute hospital journey, rehabilitation and recovery. Of concern are the risks to healthcare staff of infection arising from tracheostomy insertion and caring for patients with a tracheostomy. Hospitals are also facing extraordinary demands on critical care services such that many patients who require a tracheostomy will be managed outside established intensive care or head and neck units and cared for by staff with little tracheostomy experience. These concerns led NHS England and NHS Improvement to expedite the National Patient Safety Improvement Programme's 'Safe Tracheostomy Care' workstream as part of the NHS COVID-19 response. Supporting this workstream, UK stakeholder organisations involved in tracheostomy care were invited to develop consensus guidance based on: expert opinion; the best available published literature; and existing multidisciplinary guidelines. Topics with direct relevance for frontline staff were identified. This consensus guidance includes: infectivity of patients with respect to tracheostomy indications and timing; aerosol-generating procedures and risks to staff; insertion procedures; and management following tracheostomy.