Dr Brendan McGrath: Working with AHSNs to rapidly improve tracheostomy care during COVID-19

Dr Brendan McGrath

During the COVID-19 pandemic more patients have required ventilation support and as a result have required temporary tracheostomies. Many of these have been cared for outside intensive care units or on COVID-19 wards by staff providing care they have never previously delivered in unfamiliar environments.

In this blog Dr Brendan McGrath, national clinical advisor for the National Patient Safety Improvement Programmes’ COVID-19 safe tracheostomy care response and intensive care consultant at Manchester University NHS Foundation Trust, explains how Health Innovation Manchester and the AHSNs supported the rapid spread of safety interventions to improve care.

Watch: Dr Brendan McGrath explain the Safe Tracheostomy Response work

The COVID-19 pandemic has placed unprecedented pressure onto the healthcare system, with a surge in critically ill patients requiring ventilation support and temporary tracheostomies as they recover.

A tracheostomy is an is an artificial opening in the front of the neck into the trachea (windpipe). A small plastic tube is inserted into the neck for patients in intensive care who need help with their breathing, particularly when they’re recovering from critical illness and they’ve been on a ventilator for some time.

While the tracheostomy tube is in place it needs to be cared for to keep the airway clear and prevent complications. Patients experience problems with communication, eating and drinking as a tracheostomy affects a patient’s ability to speak and swallow. So, while tracheostomies are lifesaving for patients, they can also be life limiting and life threatening if not looked after properly.

It was vital that we could provide the staff caring for these patients with the skills and knowledge to provide the best care and ensure the environments they were working in had the appropriate infrastructure.

We looked at the results of our two-year study of 2,400 patients with tracheostomies in 20 trusts, which had found a 55% reduction in serious incident severity and a 20% reduction in length of stay in ICUs and in hospital, where key tracheostomy safety interventions were followed. Before COVID-19 hit, we had plans to launch a comprehensive package of quality improvement interventions for tracheostomy, but the pandemic accelerated the need to rapidly spread these interventions to improve care.

This is where the AHSNs have played a vital role in selecting the emergency interventions and driving the adoption and spread of the interventions across the country at pace during the COVID-19 pandemic.

Working with the AHSNs, including Health Innovation Manchester and Innovation Agency, and the Patient Safety Collaboratives, we created the Safer Tracheostomy Care toolkit as a way to boil down our big package of interventions and quality improvements into three key safety elements.

  • A standardised tracheostomy daily care bundle
  • Bedhead signs with key information about the procedure to support rapid communication in an emergency
  • Standardised ‘bedside’ tracheostomy emergency equipment available at all times

In the past quality improvement in tracheostomy has typically been driven by an individual or an individual hospital team, or in response to an isolated incident which highlights the need for improvements. But through the AHSNs and PSCs we have been able to rapidly spread the knowledge and improvements across all teams and deliver that change when it has been most needed.

We haven’t been trying to reinvent the wheel either. We’ve built on the work which started over 10 years ago here in Manchester, with the aim to improve tracheostomy care and grew into the National Tracheostomy Safety Project, taking the best experiences from not only the UK but globally, to develop the tools and resources which are being used around the world.

During the pandemic we’ve had anecdotes from patients which highlight why improving tracheostomy care is making a difference to them – the joy of being able to drink their first cup of tea after being critically ill for six weeks or telling their family they love them once their voice returned. If we can help bring these crucial moments to patients a day, a week or a month earlier by implementing quality improvement changes it can have a huge impact for the patient, their family and staff looking after them.

Bedside staff tell us that the education programme and resources we provide makes a huge difference: they are not fearful or anxious when treating patients with tracheostomies because they know they have the knowledge and access to equipment and resources they need, when they need them. More confident staff feeds through to patients, and our work has demonstrated real reductions in patient anxiety as a result of these improvements in care. This has been particularly important during the COVID-19 pandemic where more patients have required ventilation and will ensure the system is better prepared to adapt if we encounter a second wave.

Following on from this rapid improvement project, the next steps we’d like to undertake is to move sites further along the spectrum of care – from delivering good, safe care, to supporting them to deliver the best, high quality care possible for patients through the full package of QI interventions. Previous independent economic analysis estimated huge savings of up to £275million per year if all sites adopted the full tracheostomy care QI program.

And I think if we get this right, in hospital and roll out into the communities, it will have a big impact for patients, for staff and for the wider NHS, saving money and getting people out of hospital faster. This project has huge potential and I’m looking forward to continuing to work with AHSNs and PSC, building on the work we’ve undertaken during the pandemic and demonstrating that impact at scale.

Further information

Back to top