The BMJ Awards 2020: Anaesthesia and perioperative medicine team of the year

Improving tracheostomy care

Historically, tracheostomies were performed on cancer patients, who were managed on surgical wards. Nowadays, around 70% of tracheostomies are carried out by anaesthetists on intensive care patients, who are then cared for on medical wards.

There was no universal package of guidance for bedside staff—including nurses, speech therapists, and physiotherapists—to help deal with these complex patients, says Brendan McGrath, consultant anaesthetist at Manchester University NHS Foundation Trust and the national clinical adviser for tracheostomy.

His team carried out a pilot study in four Greater Manchester hospitals which showed that up to 30% of tracheostomy patients experienced an underlying incident, and delays in talking, eating, and drinking were common owing to poorly coordinated care.

McGrath led the set-up of the UK National Tracheostomy Safety Project—a multidisciplinary quality improvement programme that has now been rolled out to 20 hospitals in England. The programme includes standardising care and providing training for over 4000 members of staff. He also set up the Global Tracheostomy Collaborative, which shares good practice from exemplar hospitals around the world.

“We also got patients involved in the programme and they told us their main worries were around eating, drinking and talking,” says McGrath. The team has also created over 50 short educational videos for patients, families, and healthcare staff.

The three year improvement programme has reduced the harm from incidents by 55%. It has also resulted in higher quality care, with a 47% reduction …