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On the right trach? The national confidential review of tracheostomy care in the United Kingdom (NCEPOD)
eS1508
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS1238–eS1642
Keywords: Limb pain; Mirror therapy; Motor imagery Funding acknowledgements: The review was funded by the German Ministry for Education and Research. Ethics approval: No ethical approval was needed. http://dx.doi.org/10.1016/j.physio.2015.03.1489 Research Report Platform State of the Art Presentation Number: RR-PLSoA-1850 Monday 4 May 2015 10:45 Hall 404 ON THE RIGHT TRACH? THE NATIONAL CONFIDENTIAL REVIEW OF TRACHEOSTOMY CARE IN THE UNITED KINGDOM (NCEPOD) A.J. Thomas 1 , K. Wilksinson 2,3 , H. Freeth 3 , K. Kelly 3 1 Barts Health NHS Trust, Critical Care, London, United Kingdom; 2 Norfolk and Norwich University Hospitals NHS Foundation Trust, Anaesthesia, Norfolk, United Kingdom; 3 NCEPOD, London, United Kingdom
Background: 12,000 tracheostomies are performed per year in the United Kingdom (UK). Several reports have highlighted serious incidents directly related to tracheostomy complications. Consequently the Association of Anesthetist’s requested an NCEPOD examination of acute tracheostomy care in the UK. Physiotherapists have been identified as key members of the tracheostomy team in acute hospitals, but the scope of physiotherapy involvement in tracheostomy care nationally has never been investigated. Purpose: The aim of this study was to explore the insertion and profession specific management of tracheostomy in critical care and wards within the UK, and to make recommendations for future practice. Methods: Five questionnaires were developed to collect data:- an organizational survey by hospital; organization of ward care by hospital; tracheostomy insertion; critical care and ward based questionnaires. The latter 3 questionnaires were completed for each patient who underwent a new tracheostomy over an 11 week period. Data was collected from NHS and independent sector hospitals in England, Wales, Northern Ireland, the Channel Islands and Isle of Man. Following cleaning of the quantitative data, descriptive data summaries were produced. Results relating to physiotherapy were extracted from these summaries. Results: 219 hospitals reported 2546 tracheostomy patient cases with a mean age of 61 (16–93) yrs. Non-medically trained tracheostomy leads were reported in 50.2% of hospitals surveyed. Where a non-medically trained lead was present their primary specialty was nursing in 88 hospitals, and physiotherapy in 24 hospitals. Almost all hospitals (99.5%) had a physiotherapy unit; of those hospitals where a unit was present, 56.3% had specialist physiotherapists
for tracheostomy care. Where a physiotherapy service was present, 86% provided daily physiotherapy input (24 hours a day, 7 days a week) for patients with a tracheostomy on a general ward, and 94.1% provided input (24 hours a day 7 days a week) for patients with a tracheostomy in critical care. 57% of patients were seen by a physiotherapist less than 24 hours after tracheostomy insertion and 79.2% of patients saw a physiotherapist daily thereafter. 75% of hospitals had a planned escalation policy if physiotherapists had concerns regarding a patient. 20% of all reported decannulations were undertaken by physiotherapists. 85.4% of hospitals delivered tracheostomy training programs; however training records were maintained poorly. Regular audit of tracheostomy care was undertaken in only 21.2% of hospitals. Conclusion(s): This data demonstrates for the first time that physiotherapists within the UK have a defined and important role in the care and management of patients with a tracheostomy both within critical care and ward environments. Physiotherapists with specialist tracheostomy skills are available in more than half of UK hospitals surveyed and physiotherapists are active in leadership roles within multidisciplinary tracheostomy care. Implications: The ability of the profession to maintain and enhance its position within acute tracheostomy management will be supported by the development of national physiotherapy competencies for tracheostomy care which can be integrated into physiotherapy workforce development planning within the UK. Keywords: Tracheostomy; Critical care Funding acknowledgements: Healthcare Quality Improvement Partnership (HQUIP). Ethics approval: Approval was given by the United Kingdom Health Research Authority (HRA) and the Healthcare Quality Improvement Partnership (HQUIP). http://dx.doi.org/10.1016/j.physio.2015.03.1490 Research Report Poster Presentation Number: RR-PO-03-01-Mon Monday 4 May 2015 12:15 Exhibit halls 401–403 BENCHMARKING BASELINE REHABILITATION IN ADULT CRITICAL CARE A.J. Thomas 1 , S. Lee 2 1 Barts
Health NHS Trust, The Royal London Hospital, London, United Kingdom; 2 Barts Health NHS Trust, Clinical Support Services CAG, London, United Kingdom Background: Early rehabilitation intervention improves patient outcomes; however the onset and frequency of Physiotherapy led rehabilitation within critical care remains under evaluated. Research which evaluates rehabilitation in critical care may be influenced by a high level of baseline physical
WCPT Congress 2015 / Physiotherapy 2015; Volume 101, Supplement 1 eS1238–eS1642
Keywords: Limb pain; Mirror therapy; Motor imagery Funding acknowledgements: The review was funded by the German Ministry for Education and Research. Ethics approval: No ethical approval was needed. http://dx.doi.org/10.1016/j.physio.2015.03.1489 Research Report Platform State of the Art Presentation Number: RR-PLSoA-1850 Monday 4 May 2015 10:45 Hall 404 ON THE RIGHT TRACH? THE NATIONAL CONFIDENTIAL REVIEW OF TRACHEOSTOMY CARE IN THE UNITED KINGDOM (NCEPOD) A.J. Thomas 1 , K. Wilksinson 2,3 , H. Freeth 3 , K. Kelly 3 1 Barts Health NHS Trust, Critical Care, London, United Kingdom; 2 Norfolk and Norwich University Hospitals NHS Foundation Trust, Anaesthesia, Norfolk, United Kingdom; 3 NCEPOD, London, United Kingdom
Background: 12,000 tracheostomies are performed per year in the United Kingdom (UK). Several reports have highlighted serious incidents directly related to tracheostomy complications. Consequently the Association of Anesthetist’s requested an NCEPOD examination of acute tracheostomy care in the UK. Physiotherapists have been identified as key members of the tracheostomy team in acute hospitals, but the scope of physiotherapy involvement in tracheostomy care nationally has never been investigated. Purpose: The aim of this study was to explore the insertion and profession specific management of tracheostomy in critical care and wards within the UK, and to make recommendations for future practice. Methods: Five questionnaires were developed to collect data:- an organizational survey by hospital; organization of ward care by hospital; tracheostomy insertion; critical care and ward based questionnaires. The latter 3 questionnaires were completed for each patient who underwent a new tracheostomy over an 11 week period. Data was collected from NHS and independent sector hospitals in England, Wales, Northern Ireland, the Channel Islands and Isle of Man. Following cleaning of the quantitative data, descriptive data summaries were produced. Results relating to physiotherapy were extracted from these summaries. Results: 219 hospitals reported 2546 tracheostomy patient cases with a mean age of 61 (16–93) yrs. Non-medically trained tracheostomy leads were reported in 50.2% of hospitals surveyed. Where a non-medically trained lead was present their primary specialty was nursing in 88 hospitals, and physiotherapy in 24 hospitals. Almost all hospitals (99.5%) had a physiotherapy unit; of those hospitals where a unit was present, 56.3% had specialist physiotherapists
for tracheostomy care. Where a physiotherapy service was present, 86% provided daily physiotherapy input (24 hours a day, 7 days a week) for patients with a tracheostomy on a general ward, and 94.1% provided input (24 hours a day 7 days a week) for patients with a tracheostomy in critical care. 57% of patients were seen by a physiotherapist less than 24 hours after tracheostomy insertion and 79.2% of patients saw a physiotherapist daily thereafter. 75% of hospitals had a planned escalation policy if physiotherapists had concerns regarding a patient. 20% of all reported decannulations were undertaken by physiotherapists. 85.4% of hospitals delivered tracheostomy training programs; however training records were maintained poorly. Regular audit of tracheostomy care was undertaken in only 21.2% of hospitals. Conclusion(s): This data demonstrates for the first time that physiotherapists within the UK have a defined and important role in the care and management of patients with a tracheostomy both within critical care and ward environments. Physiotherapists with specialist tracheostomy skills are available in more than half of UK hospitals surveyed and physiotherapists are active in leadership roles within multidisciplinary tracheostomy care. Implications: The ability of the profession to maintain and enhance its position within acute tracheostomy management will be supported by the development of national physiotherapy competencies for tracheostomy care which can be integrated into physiotherapy workforce development planning within the UK. Keywords: Tracheostomy; Critical care Funding acknowledgements: Healthcare Quality Improvement Partnership (HQUIP). Ethics approval: Approval was given by the United Kingdom Health Research Authority (HRA) and the Healthcare Quality Improvement Partnership (HQUIP). http://dx.doi.org/10.1016/j.physio.2015.03.1490 Research Report Poster Presentation Number: RR-PO-03-01-Mon Monday 4 May 2015 12:15 Exhibit halls 401–403 BENCHMARKING BASELINE REHABILITATION IN ADULT CRITICAL CARE A.J. Thomas 1 , S. Lee 2 1 Barts
Health NHS Trust, The Royal London Hospital, London, United Kingdom; 2 Barts Health NHS Trust, Clinical Support Services CAG, London, United Kingdom Background: Early rehabilitation intervention improves patient outcomes; however the onset and frequency of Physiotherapy led rehabilitation within critical care remains under evaluated. Research which evaluates rehabilitation in critical care may be influenced by a high level of baseline physical