How quality improvement helped to create local guidelines for good tracheostomy care
Reviewed by Thomas William Binnersley

Significant morbidity and mortality is associated with tracheostomy insertion. A complex, multistep process exists to help patients towards decannulation. This process is often complicated by patient comorbidities, discontinuity of care and communication as patients move through hospital, and variable experience amongst treating staff. In this quality improvement project, the authors conducted an introductory analysis of 318 adult patients with tracheostomies to target where patients were suffering poor outcomes. Data concerning length of stay, intervention-related complications, mortality, timing of cuff deflation and tube exchange, and tracheostomy tube size were used to formulate a set of tracheostomy care guidelines (see these in the article’s supplementary material – they serve as an excellent practical teaching aid for clinicians learning about tracheostomy care). A squadron of ENT surgeons, nurses and educators, speech and language and respiratory therapists was amassed and tasked with implementing these guidelines. The authors demonstrate strong adherence to quality improvement methodology, justifying their intervention with reinforcement from the literature and their own rich pre-intervention dataset. Their analysis identifies how delays in progression along the tracheostomy care timeline and the lacking of standardised care protocols were associated with longer lengths of stay and greater complication rates. Comparison of pre- and post-intervention cohorts demonstrated a reduction in overall complication rate from 31.8% to 22.9%, although subgroup analyses did not reach statistical significance. Similarly, reductions in length of stay failed to achieve statistical significance but were argued to be clinically meaningful, particularly when considering the financial burden and functional deconditioning associated with a prolonged ICU admission. The authors make a compelling argument for standardised tracheostomy care in what is often a high-risk intervention performed on very poorly patients. They also provide an excellent example of how local quality improvement projects can produce meaningful improvements in care whilst generating valuable data for the wider literature

Comparison of Adult Tracheostomy Outcomes Before and After Implementation of a Dedicated Tracheostomy Team.
Palmer TT, Moore CM, Bounds-Wood KL, et al.
ANNAL OTOL RHINOL LARYNGOL
2026 [ePub ahead of print].