Tracheotomy Articles Are a Triumph of Collaboration

Rahul K. Shah, MD, George Washington University School of Medicine, Washington, DC The  AAO-HNS Patient Safety and Quality Improvement Committee and the Airway and Swallowing Committee have collaborated to publish a series of manuscripts  on tracheotomy outcomes from myriad sources, utilizing a number of differing research methodologies. With the guidance of Academy member Albert L. Merati, MD, the committees united their resources to publish what we know as the largest series of articles on tracheotomy outcomes in the literature. The significance is two-fold: 1. The articles represent a significant contribution to the regarding outcomes of patients with tracheotomies with doable items that have the potential to materially decrease adverse events and outcomes from tracheotomies. 2. The collaboration between the committees should be viewed as a model, not only within healthcare between distinct types of providers, but also within the Academy as an exercise that highlights partnership between otolaryngology specialties (many members from each respective committee are active in other special-focus specialty societies) and stakeholders. We have all known or experienced a disastrous tracheotomy outcome. However, in patient safety and quality improvement, when there are one-off events, the need to quantify the frequency of the event is important. Institutional studies are simply not powered to do this. Furthermore, it may be that the events are so rare that the frequency of such an event cannot be estimated. Nevertheless, in the tracheotomy papers three various methodologies were employed in an effort to obtain a realistic perspective on the incidence and potential opportunity for intervention in patients with tracheotomies. It was interesting that using disparate methodologies, such as conducting a national survey of surgeons, providing an analysis of a national admissions database, and researching a multi-institutional “mega-database” spearheaded by the AAO-HNS Airway and Swallowing Committee, the conclusions, imperatives, and opportunities are quite consistent. There are several action items and potential avenues for improvement from the findings of these four articles and these are articulated in an accompanying editorial by Academy members David E. Eibling, MD, and David W. Roberson, MD. The articles were published in the January issue of The Laryngoscope. The articles took a herculean effort in coordination and execution so that all the papers, which were quite large in scope, could be published in the same issue. It helps readers, especially non-otolaryngologists, to understand the scope of the problem being studied and helps to juxtapose various methodologies to allow the reader to realize the value of the results and the conclusions. The goal would be for the individual or patient safety and quality organization to read this suite of papers and become energized, as we are, with the potential for a care bundle or intervention to specifically target the issues raised by the articles. Such an initiative would, of course, need to be coordinated at a national level as tracheotomy care and outcomes transcend any one specialty or stake holder. However, the proof-of-principle, that two AAO-HNS/F committees can combine resources and their collective enthusiasm to move the discussion towards such a lofty goal, is demonstrated. In the world of patient safety and quality improvement, it is important that deference to the expert is maintained. Hence, it is somewhat disingenuous for any such committee to meddle, so to speak, into the nuances of care delivery and outcomes of disease states that are not in its direct purview. A robust methodology for patient safety and quality improvement is to have the content experts partner with those trained in quality measurement, research, etc., in order to best understand the scope of a problem and develop targeted efforts to mitigate risk. Hopefully, the collaboration, which resulted in the manuscripts noted above, will be a template for others to follow when studying patient safety and outcomes as most zones of risk are multidisciplinary and need a team of content experts to properly address the system defects. We encourage members to write us with any topic of interest and we will try to research and discuss the issue. Members’ names are published only after they have been contacted directly by Academy staff and have given consent to the use of their names.  Please email the Academy at qualityimprovement@entnet.org to engage us in a patient safety and quality discussion that is pertinent to your practice.