This is the first time I have seen a tracheostomy programme where a team is consulted and then manages and coordinates the entire procedure, as well as following the patient through their hospital admission and even after discharge.
With regards to percutaneous procedures, from my experience the MDT approach only occurs after the tracheostomy has been placed.
With this approach to a coordinated assessment and ICU consultants/attending’s having to refer for a consult when they feel a trache is required, I wanted to find out the staffs opinion of the way things run at JHH.
Because this programme has been running for around 8 years now, the general consensus is that the staff realise it’s how it’s done at JHH. From witnessing conversations between teams and different members of the MDT there was never any questioning of the teams approach or the need for a intensivist consultant to gain a consult regards placing a trache.
I am informed it was not always this way, and there was the need to educate and discuss the need for this this approach to tracheostomy care, when beginning this project. Many institutions seem to have found this.
I was lucky enough to have a discussion with Christina Miller. Christina is an anaesthetist at JHH and works with the tracheostomy team during insertions and for any consults.
When discussing the above with Christina, she recognises the challenges the team faced initially. However she explains that they emphasised the large amount of literature showing that a standardised approach and the use of your MDT provides the best outcomes for the patient. This is not just isolated to tracheostomy care.
As well as this, in these cases the tracheostomy is an elective procedure and not done because of the inability to gain an airway (emergency). Therefore there is no need to rush into placing a tube, and there is enough time to have this standardised approach.
We also discussed the procedure itself. Christina as well as a number of the surgeons commented on how much nicer and reassuring it was to have both an anaesthetist and a surgeon present. As well as the respiratory therapist. The individual members of the team all have their roles and do not have to think about maintaining a patient airway and good oxygenation whist also dealing with the complexities of the surgery. With a small amount of space available at a bedside and often with many leads and drains present, it also means staff are not having to move around the bedside to address different aspects of the procedure.
Is gaining understanding from members of your hospital staff a problem?
Is this one of the reasons why tracheostomy care teams are so difficult to establish in a hospital?