Improving the Team Response to Surgical Airway Emergencies: A Simulation-based, Multidisciplinary Approach to Quality Improvement

Abstract

Background: Early and late surgical airway complications, such as tracheostomy dislodgment, obstruction, and bleeding, are associated with a high rate of morbidity and mortality. The number of times a provider will face such a complication in their training will be limited, due to the rarity of these events. A simulation-based, multidisciplinary approach can be used to improve the quality of care delivered during these rare events. Our aim was to design and implement a simulation experience to provide trainees with the opportunity to practice team-based surgical airway emergency management.

Methods: Population: Inexperienced intensive care unit providers (novice nurses, respiratory therapy students, and junior surgery and anesthesiology residents) who care for patients with tracheostomy complications.

Setting: Simulated intensive care unit in a large urban academic hospital.

Intervention: A novel simulation curriculum was authored to reflect the tracheostomy emergency scenarios encountered in our clinical practice: early tracheostomy dislodgment, early tracheostomy obstruction, and late bleeding after tracheostomy. Multidisciplinary teams, composed of general surgery and anesthesia residents, ICU nurses and respiratory therapy students, completed a 60-minute training experience in our high-fidelity simulation lab. Post graduate year 2 or 3 general surgery residents, post graduate year 2 or 3 anesthesia residents, novice ICU nurse (less than 1 year of ICU experience), and senior respiratory therapy students were invited to participate. Participants were surveyed before and after the experience to assess their confidence. Participants were scored by a faculty moderator using a standardized checklist to assess their function as a team. Outcome and Statistical Assessment: Seven multidisciplinary teams (n = 28) were created. A composite group, consisting of all trainees, showed a statistically significant increase in reported confidence for assessing respiratory distress, communicating basic life support algorithms, and managing tracheostomy dislodgement, obstruction, and bleeding (p < 0.05). An average of 52% improvement was observed in team function from the first to third training scenario. All trainees reported a high level of satisfaction in all categories.

Conclusions: Trainees providing care in intensive care unit lack confidence in managing tracheostomy-related emergencies. Utilizing a multidisciplinary simulation-based training program in a high-fidelity simulation environment, we demonstrated improved trainee confidence and team-based management of these challenging scenarios. Future study focused on the outcomes of airway emergencies in our institution will determine whether or not this intervention can promote a culture of safety and translate to improved patient safety.

Keywords: complication; safety; simulation; tracheostomy.