1887
Volume 2022, Issue 1
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Background: Tracheostomy is among the oldest and most common surgical procedures for critically ill patients. Over the past decade, tracheostomy practice has changed regarding its indication, timing, technique, decannulation, and follow-up procedures. A systematic assessment tool for tracheostomy could maximize the quality of care and improve patient outcomes. This study develops a tool for systematically evaluating tracheostomy-related practices, assesses its validity and reliability, and conducts pilot testing of the tool.

Methods: The questionnaire development process involved three rounds using the Delphi technique with eight experts in airway management. The experts were selected from multiple healthcare specialties and workplace backgrounds. There was a two-week interval between each discussion round. In February 2019, the questionnaire themes and statements were identified through qualitative content analysis. Subsequently, in March 2019, the developed tool was emailed to 31 heads of tracheostomy care teams at multiple national hospitals for further validity and reliability assessment.

Results: The developed tool demonstrated reliability of 0.975. Tracheostomy-related practices showed acceptable levels in all 31 assessed hospitals with areas for improvement in the long-term follow-up domain.

Conclusion: This study designed a tool for the comprehensive assessment of tracheostomy-related practices. It can be used to monitor institutional outcomes, which can reduce costs. Moreover, this tool can be employed to track the improvement or deterioration of tracheostomy-related procedures and long-term follow-up to facilitate institutional progress. In addition, this tool could be used for formative and summative assessments of tracheotomy practices at national and international levels.

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2022-03-16
2022-05-17
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References

  1. Frost EA. Tracing the tracheostomy. Ann Otol Rhinol Laryngol. 1976; 85:(5 Pt.1):618–24. doi: 10.1177/000348947608500509.
    [Google Scholar]
  2. Rodríguez H, Passali GC, Gregori D, Chinski A, Tiscornia C, Botto H, et al. Management of foreign bodies in the airway and oesophagus. Int J Pediatr Otorhinolaryngol. 2012; 76:Suppl 1:S84–91. doi: 10.1016/j.ijporl.2012.02.010.
    [Google Scholar]
  3. El-Naggar M, Sadagopan S, Levine H, Kantor H, Collins VJ. Factors influencing choice between tracheostomy and prolonged translaryngeal intubation in acute respiratory failure: a prospective study. Anesth Analg. 1976; 55:(2):195–201. doi: 10.1213/00000539-197603000-00015.
    [Google Scholar]
  4. Griffiths J, Barber VS, Morgan L, Young JD. Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. BMJ. 2005; 330:(7502):1243. doi: 10.1136/bmj.38467.485671.E0.
    [Google Scholar]
  5. Carmines EG, Zeller RA. Reliability and validity assessment. Sage Publications; 1979.
    [Google Scholar]
  6. Messick S. Validity. ETS Res Rep S 1987; 1987:(2):i–208.
  7. Ciaglia P, Firsching R, Syniec C. Elective percutaneous dilatational tracheostomy. A new simple bedside procedure; preliminary report. Chest. 1985; 87:(6):715–9. doi: 10.1378/chest.87.6.715.
    [Google Scholar]
  8. Krishnan K, Elliot SC, Mallick A. The current practice of tracheostomy in the United Kingdom: a postal survey. Anaesthesia. 2005; 60:(4):360–4. doi: 10.1111/j.1365-2044.2004.04106.x.
    [Google Scholar]
  9. Byhahn C, Lischke V, Halbig S, Scheifler G, Westphal K. [Ciaglia Blue Rhino: a modified technique for percutaneous dilatation tracheostomy. Technique and early clinical results.] Anaesthesist. 2000; 49:(3):202–6. German. doi: 10.1007/s001010050815.
    [Google Scholar]
  10. Griggs WM, Worthley LI, Gilligan JE, Thomas PD, Myburg JA. A simple percutaneous tracheostomy technique. Surg Gynecol Obstet. 1990; 170:(6):543–5.
    [Google Scholar]
  11. Sugerman HJ, Wolfe L, Pasquale MD, Rogers FB, O'Malley KF, Knudson M, et al. Multicenter, randomized, prospective trial of early tracheostomy. J Trauma. 1997; 43:(5):741–7. doi: 10.1097/00005373-199711000-00002.
    [Google Scholar]
  12. Lesnik I, Rappaport W, Fulginiti J, Witzke D. The role of early tracheostomy in blunt, multiple organ trauma. Am Surg. 1992; 58:(6):346–9.
    [Google Scholar]
  13. Rodriguez JL, Steinberg SM, Luchetti FA, Gibbons KJ, Taheri PA, Flint LM. Early tracheostomy for primary airway management in the surgical critical care setting. Surgery. 1990; 108:(4):655–9.
    [Google Scholar]
  14. Freeman BD. Tracheostomy update: when and how. Crit Care Clin. 2017; 33:(2):311–22. doi: 10.1016/j.ccc.2016.12.007.
    [Google Scholar]
  15. Garuti G, Reverberi C, Briganti A, Massobrio M, Lombardi F, Lusuardi M. Swallowing disorders in tracheostomised patients: a multidisciplinary/multiprofessional approach in decannulation protocols. Multidiscip Respir Med. 2014; 9:(1):36. doi: 10.1186/2049-6958-9-36.
    [Google Scholar]
  16. Hopkins C, Gillett S, Slack R, Lund VJ, Browne JP. Psychometric validity of the 22-item Sinonasal Outcome Test. Clin Otolaryngol. 2009; 34:(5):447–54. doi: 10.1111/j.1749-4486.2009.01995.x.
    [Google Scholar]
  17. Niederberger M, Spranger J. Delphi technique in health sciences: A map. Front Public Health. 2020;8:457. doi: 10.3389/fpubh.2020.00457.
    [Google Scholar]
  18. Yousuf MI. Using experts’ opinions through Delphi technique. Pract Assess Res Eval. 2007;12:4. doi: 10.7275/rrph-t210.
    [Google Scholar]
  19. Benoot C, Hannes K, Bilsen J. The use of purposeful sampling in a qualitative evidence synthesis: A worked example on sexual adjustment to a cancer trajectory. BMC Med Res Methodol. 2016;16:21. doi: 10.1186/s12874-016-0114-6.
    [Google Scholar]
  20. Humphrey-Murto S, Varpio L, Gonsalves C, Wood TJ. Using consensus group methods such as Delphi and Nominal Group in medical education research. Med Teach. 2017; 39:(1):14–9. doi: 10.1080/0142159X.2017.1245856.
    [Google Scholar]
  21. Ab Latif R, Dahlan A, Mulud ZA, Nor MZM. (2017). The Delphi technique as a method to obtain consensus in health care education research. Education in Medicine Journal. 2017; 9:(3):89–102. doi: 10.5959/EIMJ.V9I3.548.
    [Google Scholar]
  22. Hasson F, Keeney S, McKenna H. Research guidelines for the Delphi survey technique. J Adv Nurs. 2000; 32:(4):1008–15. doi: 10.1046/j.1365-2648.2000.t01-1-01567.x.
    [Google Scholar]
  23. Miller LE. Determining what could/should be: the Delphi technique and its application. Proceedings of the 2006 annual meeting of the Mid-Western Educational Research Association; 2006; Columbus, Ohio.
    [Google Scholar]
  24. Gliem JA, Gliem RR. Calculating, interpreting, and reporting Cronbach's alpha reliability coefficient for Likert-type scales. Proceedings of the midwest research practice conference in adult, continuing, and community education; 2003; Columbus, Ohio.
    [Google Scholar]
  25. Connelly LM. Cronbach's alpha. Medsurg Nurs. 2011; 20:(1):45,44.
    [Google Scholar]
  26. Ferketich S. Internal consistency estimates of reliability. Res Nurs Health. 1990; 13:(6):437-440. doi: 10.1002/nur.4770130612.
    [Google Scholar]
  27. Cox CE, Carson SS, Holmes GM, Howard A, Carey TS. Increase in tracheostomy for prolonged mechanical ventilation in North Carolina, 1993–2002. Crit Care Med. 2004; 32:(11):2219–26. doi: 10.1097/01.ccm.0000145232.46143.40.
    [Google Scholar]
  28. Frutos-Vival F, Esteban A, Apezteguía C, Anzueto A, Nightingale P, González M, et al. Outcome of mechanically ventilated patients who require a tracheostomy. Crit Care Med. 2005; 33:(2):290–8. doi: 10.1097/01.ccm.0000150026.85210.13.
    [Google Scholar]
  29. Cox CE, Martinu T, Sathy S, Clay AS, Chia J, Gray AL, et al. Expectations and outcomes of prolonged mechanical ventilation. Crit Care Med. 2009; 37:(11):2888–94. doi: 10.1097/CCM.0b013e3181ab86ed.
    [Google Scholar]
  30. Lewarski JS. Long-term care of the patient with a tracheostomy. Respir Care. 2005; 50:(4):534-7.
    [Google Scholar]
  31. Hussler C, Muller P, Ronde P. Is diversity in Delphi panelist groups useful? Evidence from a French forecasting exercise on the future of nuclear energy. Technol Forecast Soc Chang. 2011; 78:(9):1642–1653. doi: 10.1016/j.techfore.2011.07.008.
    [Google Scholar]
  32. Mehta AB, Syeda SN, Bajpayee L, Cooke CR, Walkey AJ, Wiener RS. Trends in tracheostomy for mechanically ventilated patients in the United States, 1993–2012. Am J Respir Crit Care Med. 2015; 192:(4):446–54. doi: 10.1164/rccm.201502-0239OC.
    [Google Scholar]
  33. Cooper RM. Use and safety of percutaneous tracheostomy in intensive care: Report of a postal survey of ICU practice. Anaesthesia. 1998; 53:(12):1209–12. doi: 10.1046/j.1365-2044.1998.00579.x.
    [Google Scholar]
  34. Fikkers BG, Fransen GA, van der Hoeven JG, Briedé IS, Van Den Hoogen FJ. Tracheostomy for long-term ventilated patients: a postal survey of ICU practice in The Netherlands. Intensive Care Med. 2003; 29:(8):1390–3. doi: 10.1007/s00134-003-1824-x.
    [Google Scholar]
  35. Vargas M, Sutherasan Y, Antonelli M, Brunetti I, Corcione A, Laffey JG, et al. Tracheostomy procedures in the intensive care unit: an international survey. Crit Care. 2015; 19:(1):291. doi: 10.1186/s13054-015-1013-7.
    [Google Scholar]
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