What did we do?

The Safer Tracheostomy Care in Adults bundle was a programme of 18 interventions implemented across 20 hospitals in England between August 2016 and January 2018. These 18 interventions were designed to improve the quality and safety of care for patients who have had tracheostomies. We looked at the potential impacts of a wider national rollout of the Safer Tracheostomy Care initiative.

 

 

Why was it important?

Inconsistent and poorly coordinated systems of tracheostomy care commonly result in frustrations, delays, and harm. However, quality improvement strategies described by hospitals involved with the Global Tracheostomy Collaborative (GTC) have demonstrated ways to potentially to mitigate these issues [1]. 

 

Hospitals that implemented the Safer Tracheostomy Care initiative interventions saw improvements across a number of quality, safety and efficiency for patients who had tracheostomies, these improvements included:

 

• reduced length of stay in hospital, 
• reduced incident severity, and 
• reductions in anxiety and depression [2]

 

The level of these improvements varied across hospitals, as did the type of interventions implemented. The hospitals also had different characteristics and populations which they served.

In 2020, the NHS England Safer Tracheostomy Care National Patient Safety Improvement Program (NatPatSIP) rapidly implemented several of the key interventions from the 20 site Improving Tracheostomy Care programme to a number of hospitals across England. 

 

 

How did we do it?

Using the data from the 20 site Improving Tracheostomy Care programme, we looked to answer the following key questions:

 

• What aspects of the quality improvement scheme drove impact in the 20 site pilot, and how did this vary according to hospitals’ profiles?
• What would be the expected impacts from a national rollout based on the interventions introduced in the 20 site pilot, and the profile of the hospitals?

 

The first part of our analysis involved the use of multiple regression models, with the second stage focussing on applying the estimates of the impact of the interventions and site characteristics to observational data, to be able provide estimated impacts for the individual sites involved in the wider roll-out. 

 

 

Findings

In the observed 20 pilot hospitals, our evaluation found reductions in the following:

 

• average hospital length of stay
• average number of days with a tracheostomy
• average number of days spent in the Intensive Care Unit
• average number of days spent on a ventilator

 

We estimated the potential benefits of the improvement programme for the 180 hospitals included in the Safer Tracheostomy Care initiative. On average, the estimates showed a reduction in total hospital length of stay per tracheostomy admission of 33.02 days, corresponding to a potential reduction of over £27,000 per admission.

 

Study limitations meant a pragmatic approach was taken to evaluate strategies to improve quality in tracheostomy care. Due to a lack of data, the evaluation was limited in its opportunities to identify the impacts of quality improvement strategies on the 180 non-pilot hospitals and relying on the estimated effects of the 20 pilot hospitals could lead to inaccurate measures of impact.

 

The full evaluation report and summary report are available below.

 

• Reports

  • Full Report - Estimating the potential benefits of a patient safety quality improvement scheme on safer tracheostomy care introduced at scale in NHS hospitals in England (Published April 2023)

  • Summary Report - Estimating the potential benefits of a patient safety quality improvement scheme on safer tracheostomy care introduced at scale in NHS hospitals in England (Published April 2023)

     

 

 

Who did we work with?

• NHS England
• Manchester University NHS Foundation Trust

 

 

More information

 

 

 

Programme Manager
Cristianne Bukhari
cristianne.bukhari@manchester.ac.uk