Otolaryngology-Head and Neck Surgery

CLINICAL HIGHLIGHTS

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Written by Staff

(L to R): Christopher Leto (PGY5), Michael Groves (Program Director), Thomas Holmes (PGY2), Daniel Sharbel (PGY3), Renee Booth (PGY2)

 

Quality Improvement Symposium

In early May, our department was proud to play a major role in Augusta University Medical Center’s inaugural Quality Improvement Symposium. Through his work chairing our institution’s Graduate Medical Education Subcommittee for Quality Improvement, Dr. Michael Groves realized that there were a lot of resident-driven projects that were being completed for quality improvement that no one really knew about. This inspired him to propose a hospital-wide Quality Improvement Symposium, showcasing the best quality improvement projects that had been completed at AU in the last two years.

Hospital leadership was excited about the idea and jumped on board, offering prize money for the top three projects. The prize money will be used by the winning departments to pursue future quality improvement efforts, thus perpetuating the QI cycle. The event was a rousing success with nearly 50 project submissions, 26 of which were chosen to be highlighted in poster form at the Symposium. A great crowd of physicians, nurses, medical students, hospital staff, patients and families flowed through the poster session over two hours, asking questions and giving great feedback to the presenters.

The Department of Otolaryngology – Head and Neck Surgery was well represented with 4 posters, and chief resident, Dr. Chris Leto, and his team won the 3rd Place Prize for their project, “Eliminating Tracheostomy Tube-Related Pressure Injuries in Adults.” All in all, the Symposium was a huge success and looks like it will become an annual event, proving that quality improvement is a vital part of what we do and how we here at AU strive to provide the best care possible to our patients.

(L to R): Daniel Sharbel (PGY3), Christopher Leto (PGY5), Phillip Coule (CMO), Thomas Holmes (PGY2), Stil Kountakis (Chair), Renee Booth (PGY2)

 

Quality Improvement Project

Eliminating Tracheostomy Tube-Related Pressure Injuries in Adults

Christopher J. Leto, M.D.1, Daniel J. Carroll, M.D.1, Mark A. Fritz, M.D.2, Brian Ho, M.D.3, J. Kenneth Byrd, M.D., FACS1, Michael W. Groves, M.D., FACS1, Kevin C. Dellsperger, M.D., PhD4, Stilianos E. Kountakis, M.D., PhD, FACS1, Gregory N. Postma MD1

1Augusta University, Department of Otolaryngology–Head & Neck Surgery, Augusta, GA
2University of Kentucky, Department of Otolaryngology–Head & Neck Surgery, Lexington, KY
3Nicklaus Children’s Hospital, Miami, FL
4Augusta University, Augusta University Health, Augusta, GA

Background

Medical device related pressure injuries are under scrutiny due to the impact on Medicare reimbursement and to increased attention by payers to focus on quality metrics in health care. We assessed the frequency of tracheostomy tube-related pressure injuries (TTRPI) in adults requiring mechanical ventilation who underwent a tracheostomy following implementation of a protocol to reduce and potentially eliminate these injuries.

Methods

All adult patients who underwent tracheostomy by otolaryngologists from July 1, 2016 to February 28, 2018 had the following modifications to the surgical technique: foam collar placed rather than twill tie to secure the tracheostomy tube around the neck; hydrocolloid placed superior and inferior to the skin incision to buffer the flange; a deliberate air knot thrown in the four-point securing sutures. On post-operative day 3, the hydrocolloid was removed and the sutures cut. Increased purposeful communication with nurses and respiratory therapists enhanced attention to risk factors for TTRPIs. Number of TTRPIs were compared pre and post-intervention.

Results

Ten TTRPIs occurred in 9 patients (10.6%) who underwent tracheostomy (n=85) in the twelve month pre-intervention period; 90% (n=9) were flange related and 10% (n=1) from the twill tie. In the nineteen-month period after protocol implementation, there were zero TTRPIs in 137 adult patients who underwent tracheostomy by otolaryngologists.

Conclusion

Enhanced communication, awareness, responsibility, and changes to perioperative tracheostomy protocols eliminated TTRPIs in adult patients at our institution. Our results suggest that further study is warranted and potential widespread implementation may significantly decrease the incidence of TTRPIs in adults who undergo tracheostomy.