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  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.

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  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.