Transforming tracheostomy care within the complexities of the NHS: a Q&A with Brendan McGrath

Patient perspectives are at the heart of a new approach to tracheostomy care which has been successfully tested in Manchester and is now being rolled out to sites across the UK, supported by a Health Foundation Spreading Improvement grant. We spoke to project lead Brendan McGrath, Consultant in Anaesthesia and Intensive Care Medicine at University Hospital South Manchester and National Clinical Advisor for Tracheostomy at NHS England, to find out more.

Tell us about the work you’ve done in Manchester through the Improving Tracheostomy Care project.

Each year, around 15,000 patients in England and Wales have a tracheostomy – a surgical procedure where a tube is inserted into the windpipe (trachea) to help someone breathe. Many of those people have complex health problems and complications arise for a third of patients on wards and a quarter of patients in intensive care units – a worryingly high rate.

In our Shine 2014 project, funded by the Health Foundation, we worked with teams at four sites to introduce evidence-based resources and interventions developed by the Global Tracheostomy Collaborative (GTC) to improve care quality and patient safety. The areas we focused on included staff knowledge of tracheostomy care, establishing multidisciplinary teams, involving patients and families, and benchmarking local performance against international peers.

How did this change things for patients?

We achieved significant reductions in harm to patients and reduced the average of length of hospital stay, but also made big improvements in patient-focused measures like the amount of time taken to speak or eat after a tracheostomy.  We know from talking to patients that what they often care most about is how a tracheostomy will affect their day-to-day life, so measures like this really matter.

Working as part of a multidisciplinary team sped up the process of identifying patients who can swallow safely and return to eating, and also arranging further care for patients who needed more help with swallowing. We were able to reduce the average gap from tracheostomy to eating by around five days.

Each of the sites had a ‘patient champion’ with personal experience of what it’s like to have a tracheostomy. One of the patient champions told us he’d often seen staff on the unit asking for help or looking unsure about how to do something relating to his tracheostomy, which made him feel anxious. As our project progressed, he noticed that the staff were more confident and knowledgeable, and this helped to relieve his anxieties.

How will you spread what you’ve learnt in Manchester into other areas?

We’re at the start of an exciting new phase of our project – over the next two years we’ll be using the Health Foundation Spreading Improvement grant to extend the project to 20 sites. Having the Health Foundation as a partner has helped to generate a lot of interest in what we’re doing – from potential sites, the Royal Colleges and organisations such as the Institute for Healthcare Improvement in the US.

As the rollout gets underway, we’ll be working closely with each site to introduce them to the GTC resources – the educational tools, the stories from exemplar projects around the world, the patient champions model and the benchmarking database. We’ll also be supporting the sites to embrace change where it’s needed, for example by setting up multidisciplinary tracheostomy teams.

What challenges do you think you’ll face along the way?

Every site will be different – some teams will have more experience and knowledge than others, some will be more open to new ways of working than others. I think it’ll be important for us to understand the patient safety data for each area, so that we have a local perspective on the challenges they’re facing and the opportunities for improvement.

What impact do you hope the project will have?

We want to create an evidence base for what works in improving tracheostomy care within the complexities of the NHS – the impact on quality, safety, and patient experience, and the potential cost savings. We’ll use the findings to develop a resource pack which other hospitals can use to run their own improvement projects. In the longer term, I hope we’ll be able to make a strong case that the GTC approach should become a nationally-funded model of care.

This project was initially funded by a Health Foundation Shine 2014 grant and is now being supported by our Spreading Improvement grant programme.