By: Emily Field, Communications Specialist, Chatham-Kent Health Alliance
Throughout the COVID-19 pandemic, hospitals across the province have increasingly seen an uptake in critically ill patients due to the virus and its recent variants of concern. Health care workers caring for these critical patients have been forced to navigate many new terrains throughout this unprecedented time, making skill enhancement key within critical care settings. Respiratory Therapists (RTs) are a crucial human resource at CKHA and play a vital role in the care of these patients. Through a recent training and educational initiative, RTs at Chatham-Kent Health Alliance (CKHA) were given the opportunity to enhance their skills and build their confidence in after care for tracheostomies with a newly developed tracheostomy care course by the organization's own head and neck surgeons.
Since the outset of the pandemic, the number of tracheostomies performed has increased exponentially at CKHA – a trend also seen across the province. To enhance and refine after care of these procedures at CKHA, Dr. Nadine Yammine, Otolaryngology/Laryngology with Dr. Diana Khalil, Otolaryngologist, collaborated to develop a first-of-its-kind tracheostomy care course for CKHA's RTs. During a tracheostomy procedure, a tube is inserted into an individual's neck to aid with breathing and bypass the upper airway; this type of procedure assists many patients who require ventilation to wean off the ventilator in a shorter time span. After ventilation is no longer required, patients can often move to a more progressive care setting outside of the Intensive Care Unit (ICU).
"Although Otolaryngology Specialists are very comfortable performing tracheostomy procedures as part of their routine training, RTs play an important role in providing after care for these procedures. With the number of tracheostomies increasing, a need for additional training was identified to increase our RTs skill and comfort in this area," said Dr. Yammine.
Together, Drs. Yammine and Khalil designed this course with a lecture and hands-on component focused on broadening the RTs level of comfort in managing and avoiding complications from tracheostomies. With COVID-19 safety in mind, the training was spilt into two days with each group divided further into two sub-groups during the hands-on portion to respect social distancing.
Jaimi Chauvin, a recent Respiratory Therapy graduate in her early career at CKHA, found the training to be an informative refresher on tracheostomy care.
"It was great to touch up on topics learned in school and connect it with our care at CKHA. Also, getting to meet the Otolaryngology Specialists personally and understand their expectations of the RTs here. A lot of great information was shared between the physicians and RTs to expand our knowledge on tracheostomy patients and how to navigate safely around problems that may occur, as well as creating plans to improve patient care," said Ms. Chauvin.
Sally Gutoskie, an RT and Anaesthesia Assistant with over 20 years of service at CKHA, walked away from the workshop feeling increased confident in her skills.
"It was a very thorough review and I learned a lot of new things. It was good to have hands-on training and overall it was a very informative workshop. I definitely feel even more confident in my skills," said Ms. Gutoskie.
Within larger hospital teaching sites, tracheostomy education is a common opportunity due to the established educational settings at these sites. With the desire to improve upon safe, high quality patient care, Drs. Yammine and Khalil approached the hospital's administration with the indication that this training was important to offer RTs within the organization.
"Our Senior Team here at CKHA has been very supportive of this endeavour. We appreciate their support which has allowed us to organize and teach this course. Having surgeons organize and teach these workshops, and having our Senior Team support our efforts, embodies the collaboration necessary in a community hospital like ours to maintain up-to-date skills and deliver the highest level care to our critically ill patients. These skills that have been necessary to maintain during this pandemic," said Dr. Yammine.
"When I was approached by the offer to hold an educational training session for the RTs, I immediately accepted. This type of collaboration between front line RTs and physicians is exactly what we want for our patients. It is completely focused on patient care, safety, and excellence in the field of caring for critically ill patients," said Cynthia Stulp, Manager, Respiratory Therapy, CKHA.
In addition to the RTS familiarizing themselves with the variety of tracheostomy tubes used in the hands-on portion of the training, CKHA has also recently launched a Bedside Percutaneous Tracheostomy program. This program has provided the resources for Otolaryngology Specialists to perform tracheostomies at the bedside in the ICU rather than transferring patients to the Operating Room (OR). In this bedside procedure, Otolaryngologists will perform the tracheostomy along with Intensivist Physicians who will assist with a simultaneous bronchoscopy to visualize the airway on a screen during the procedure.
"Performing this procedure at the bedside is better for patients overall who fit the criteria. It is minimally invasive and it avoids that transfer to the OR," said Dr. Yammine. She added, "It certainly is better use of our hospital resources and precious OR time can be used for other procedures. This also decreases the wait time for critically ill patients waiting for an OR to become available to have a tracheostomy at a time where our resources are even more scarce. "
With this new tracheostomy care course, CKHA has become an early pioneer for this type of training within a community hospital setting. Coupled with the Bedside Percutaneous Tracheostomy program, these recent initiatives continue to transform and enhance the safe, high quality patient care that CKHA strives to provide daily.