Follow

• 

  Exposure of Tracheostomy Education Well-Received During Pre-Clinical Head and Neck Physical Exam Course

  Tony Satroplus, Jayme Dowdall, Chris Bingcang, Tony Richa, and Katie Geelan-Hansen

  Objective: Previous tracheostomy education programs have focused on many healthcare personnel populations including non-surgical residents and senior level medical students. However, the impact of tracheostomy educations programs on pre-clinical medical students has not been investigated. This pilot QI study aims to demonstrate that a concise hands-on tracheostomy education course can provide pre-clinical medical students adequate instruction and improve confidence in providing care for tracheostomy patients.

  Methods: This pilot quality improvement study included academic otolaryngologists across multiple subspecialties providing concise hands-on tracheostomy education as part of a mandatory head and neck physical examination course for all medical students. A mannequin with a tracheostomy was assigned to each small group and clinical situations were simulated. Time was allowed for questions and further independent practice. Students were asked to complete an anonymous questionnaire prior to and following the course which included a knowledge assessment and inquiry on the confidence level of each scenario based on a rating of 1 (not confident) to 4 (very confident). Seventy-nine pre-clinical medical students completed both surveys. A two-sample paired t-test was utilized to compare changes in confidence and knowledge.

  Results:Of the 79 students who completed both surveys, 10% had previously participated in tracheostomy training. Scores for the confidence assessment increased by an average of 110% (p

  Conclusion: Pre-clinical medical students benefit from a tracheostomy education component included in their head and neck physical exam course. Feedback supported the course being well-received, well-timed, and appropriately concise.

• 

  Virtual Reality Anatomical Simulation for Skull Base Surgery

  Tony Satroplus, Steven Goicoechea, Jer Weann Ang, Jeremiah J. Wilt, Wesley A. Fisher, Dheeraj Varandani, and Christie Barnes

  Background

  Little work has been published on virtual reality simulations in skull base surgery. This study aims to elucidate on the technical development, subjective evaluation, and future improvements of a virtual reality anatomical simulation for skull base surgery.

  Methods:

  A multidisciplinary group of physicians, computer scientists, and anatomical illustrators contributed to a virtual reality simulation targeting the anatomy of skull base surgery. Various patient’s CT scan data of the skull and vasculature was segmented using AMIRA, and refined in ZBrush for anatomical accuracy including true foramina. Models were meticulously aligned and retopologized to reduce total polygon count, optimizing them for use in virtual reality. A prototype of the application was then created in ShapesXR, imported into Unity, and made available on the Meta Quest 3 headset. Feedback was given by a select group of testers throughout the development process.

  A survey was developed based on the evidence-based 5-point Likert scale for clinical simulator surveys. Participants in a resident-focused skull base surgery course were enrolled to provide feedback on the simulation.

  Results

  Challenges of simulation development center on reconstructing thin areas, including the various foramina, from segmented data. Sixteen participants with various training backgrounds, including medical students, otolaryngology and neurosurgery residents, and faculty completed the survey following the skull base anatomy and endoscopy dissection course. Course surveys demonstrated 75% of participants agreed or strongly agreed that the VR/3D model was helpful in preparing for endoscopic dissection. All course participants agreed (44%) or strongly agreed (56%) that they would recommend VR/3D model training prior to endoscopic dissection and/or operative experience. The most significant barrier was the learning curve of the VR technology (57%).
  

  Conclusion

  High-fidelity anatomical and surgical simulations continue to allow trainees to gain experience with a procedure in a low-risk environment. Our study's participants suggested this simulation would be a helpful steppingstone before completing complex skull base procedures in the operating room. Further work will focus on increasing fidelity and usability of the simulation.

• 

  Development of Adult Multidisciplinary Tracheostomy Rounding Teams: Prevalence, Template for Starting, and Analysis for Diffusion of Innovation

  Tony Satroplus, Teresa Y. Rodriguez, Bennett J. Berning, Sarah Schmoker, Robert Morrison, and Jayme Dowdall

  Educational Objective: At the conclusion of this presentation, the participants should be able to (a) Describe the prevalence of adult tracheostomy teams in the Middle Section; (b) Outline the impact of dedicated tracheostomy rounding teams; (c) Craft strategies for multidisciplinary rounding team including the necessary personnel; (d) Identify accelerants and barriers to incorporation of the team at their institution or community. Objectives: Multidisciplinary tracheostomy rounding teams have been found to decrease days to speech and decannulation and decrease adverse events. The need of such teams and the characteristics that increase or inhibit the tracheostomy rounding team's implementation rates have not been well described. This quality improvement study and intervention aimed to (a) characterize the prevalence of inpatient teams dedicated to adult tracheostomy patients in the Middle Section; (b) describe strategies to develop a dedicated tracheostomy rounding team; (c) discuss plans to optimize Diffusion of the innovation based on Rodgers’ 1962 text that will increase adoption at other Middle Section institutions. Study Design: This prospective and retrospective quality improvement study both quantitatively and qualitatively analyzed the need, development, and implementation of a multidisciplinary tracheostomy rounding team at two Middle Section institutions. Methods: Inquiries were sent to academic departments throughout the programs in the Middle Section of the Triological Society regarding the presence of a dedicated adult team. Two institutions simultaneously formed tracheostomy teams with different strategies. Results: Only one of the academic departments that responded had a dedicated tracheostomy rounding team for adults. Analyzing the process of our tracheostomy team development, we share strategies to enhance the diffusion process, while recognizing that the time constraints and compensation of the stakeholders involved could be barriers moving forward. Conclusion: Overall, despite literature demonstrating that tracheostomy rounding teams lead to improved patient care and better navigation of the healthcare system by patients and their families, this type of multidisciplinary intervention is underutilized at many programs. Characterizing the development of a tracheostomy rounding team and creating a collaborative network for feedback and implementation help is necessary for its continued momentum and effectiveness.

• 

  Improving the Usability and Usage of a Tracheostomy Order Set

  Tony Satroplus, Teresa Y. Rodriguez, Jordon Flynn, Carly Garcia, Bennett J. Berning, and Jayme Dowdall

  Educational Objectives: At the conclusion of this presentation, the participants should be able to (a) understand the benefits of simplifying EMR order-sets; (b) simplify a commonly used procedure or order set which includes identifying stakeholders who should contribute to the discussions; (c) identify and overcome barriers that would inhibit implementation and efficiency Objectives: Usability of electronic medical records has been linked to concerns for patient safety and provider wellness. One concern is that an order set’s “end user” may be inexperienced with the complexities associated with the tracheostomy patient continuum. The formation and utility of an intuitive workflow in the entire care continuum has not been investigated. This quality improvement project aimed to (a) Improve order set usability; (b) Create a multidisciplinary process to overhaul a clinical order set at a single institution with stakeholder engagement across service lines; (c) Address barriers to implementation and dissemination with processes and stakeholder groups. Study design: A quality improvement project focused on the multidisciplinary creation and analysis of the impact of simplification on a process within the EMR at a single institution. Methods The workflow of a self-organized multidisciplinary working group was documented and end users were identified. An implementation plan was crafted and use was tracked. Special attention was made to unintended consequences. Results Six multidisciplinary meetings took place. Each meeting included suggestions for improvements and discussions regarding the impact of each change on the many stakeholders. We found opportunity to defer practice to hospital policy. We also found opportunity to remove education from the order set. Feedback and analyses from this intervention revealed improved efficiency with 42% fewer clicks and 60% fewer clinical decisions required for completion of the order set. More importantly, residents at both the junior and senior levels commented that the increased simplicity and efficiency has improved workflow during times when they are on call and most fatigued. Barriers to implementation included some hospitals within the system not wishing to move forward and turnover of end users in an academic institution. Conclusion Assembling a multidisciplinary team to improve the usability of a tracheostomy order set provides an opportunity for seamless implementation of hospital policies across service lines. This may be a generalizable pathway to a standardized care continuum without a dedicated tracheostomy team.