Tracheostomy clinical practices and patient outcomes in three tertiary metropolitan hospitals in Australia.

BACKGROUND: There is a paucity of literature in Australia on patient-focused tracheostomy outcomes and process outcomes. Exploration of processes of care enables teams to identify and address existing barriers that may prevent earlier therapeutic interventions that could improve patient outcomes following critical care survival. OBJECTIVES: The objectives of this study were to examine and provide baseline data and associations between tracheostomy clinical practices and patient outcomes across three large metropolitan hospitals. METHODS: We performed a retrospective multisite observational study in three tertiary metropolitan Australian health services who are members of the Global Tracheostomy Collaborative. Deidentified data were entered into the Global Tracheostomy Collaborative database from Jan 2016 to Dec 2019. Descriptive statistics were used for the reported outcomes of length of stay, mortality, tracheostomy-related adverse events and complications, tracheostomy insertion, airway, mechanical ventilation, communication, swallowing, nutrition, length of cannulation, and decannulation. Pearson's correlation coefficient and one-way analyses of variance were performed to examine associations between variables. RESULTS: The total cohort was 380 patients. The in-hospital mortality of the study cohort was 13%. Overall median hospital length of stay was 46 days (interquartile range: 31-74). Length of cannulation was shorter in patients who did not experience any tracheostomy-related adverse events (p= 0.036) and who utilised nonverbal communication methods (p = 0.041). Few patients (8%) utilised verbal communication methods while mechanically ventilated, compared with 80% who utilised a one-way speaking valve while off the ventilator. Oral intake was commenced in 20% of patients prior to decannulation. Patient nutritional intake varied prior to and at the time of decannulation. Decannulation occurred in 83% of patients. CONCLUSIONS: This study provides baseline data for tracheostomy outcomes across three large metropolitan Australian hospitals. Most outcomes were comparable with previous international and local studies. Future research is warranted to explore the impact of earlier nonverbal communication and interventions targeting the reduction in tracheostomy-related adverse events.

Can human mannequin-based simulation provide a feasible and clinically acceptable method for training tracheostomy management skills for speech-language pathologists?

PURPOSE: Workplace training for tracheostomy management is currently recognized to be inconsistent and insufficient. A novel approach, using technology-enhanced simulation, may provide a solution to training tracheostomy management skills by providing a consistent, time-efficient, and risk-free learning environment. The current research evaluated clinicians' tracheostomy skills acquisition after training in a simulated learning environment and explored changes in clinicians' confidence and perceptions after the experience. METHOD: Forty-two clinicians with no or low levels of tracheostomy skill attended one of six, 1-day simulation courses. The training involved both part-task skill learning and immersive simulated scenarios. To evaluate clinicians' acquisition of manual skills, performance of core tasks during the scenarios was assessed by independent observers. Questionnaires were used to examine perceived outcomes, benefits, and perceptions of the learning environment at pre-, post-, and 4 months post-training. RESULTS: Only 1 clinician failed to successfully execute all core practical tasks. Clinicians' confidence increased significantly ( p < .05) from pre- to post-workshop and was maintained to 4 months post-workshop across most parameters. All clinicians reported positive perceptions regarding their learning outcomes and learning in a simulated environment. CONCLUSION: These findings validate the use of simulation as a clinical training medium and support its future use in tracheostomy competency-training pathways.

African American caregivers and HIV/AIDS formal resources.

The African American community continues to be disproportionately affected by the human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) in many ways. In addition to the prevalence rates of the disease in the community, caregivers of people living with HIV/AIDS continue to be challenged as they strive to provide care and support to love ones. The purpose of this pilot study is to explore how African American caregivers of adults living with HIV/AIDS engage available formal resources within their community. African American caregivers (N = 10) were recruited from Long Island, New York and interviewed using unstructured and semi-structured questions. The caregivers' use of community resources were associated with circulating communication within the community about the resource. For example, formal (health & social) resources were recommended and/or accessed if the resource had a positive, historical past of rendering culturally sensitive and medically competent care to the African American community. Recommendations for further study and community- level implications for health care professionals are suggested.