(0234) Optimizing Timely Tracheostomy Decannulation After Head and Neck Cancer Surgery: An Educational Quality Improvement Intervention

Introduction: The postoperative care of patients undergoing head and neck cancer (HNC) surgery with free flap reconstruction is guided by the Enhanced Recovery After Surgery (ERAS) pathway. Institutionally, a rate-limiting step in pathway adherence is timeliness of tracheostomy decannulation. This quality improvement (QI) initiative aimed to identify and address educational needs among key stakeholders in tracheostomy management.

Methods: This prospective survey-based cohort study is aimed at identifying knowledge gaps and perceived barriers to timely decannulation among otolaryngology head and neck surgery (OHNS) attending physicians, residents, nurses, and respiratory therapists (RTs). Survey content was validated by expert stakeholders prior to dissemination over a two-week period. Responses were analyzed, categorized into themes, and translated into educational objectives, which informed an educational session delivered to key stakeholders.

Results: In total, 40 responses were recorded from OHNS attending physicians (n = 4), residents (n = 4), nurses (n = 18), and RTs (n = 14). Perceived barriers to timely decannulation included tracheostomy complications (70.0%), inter-provider communication deficiencies (57.5%), and limited ERAS pathway understanding (30.0%). Perceived challenges in tracheostomy management included tracheostomy bleeding (47.5%) and tracheostomy tube size selection (32.5%). Perceived educational needs focused on improving communication between providers (72.5%) and with patients (52.5%). The identified themes were incorporated into an educational session delivered to key stakeholders.

Conclusions: This QI initiative builds upon the distinct educational needs of key stakeholders in tracheostomy management. We identified educational gaps in key aspects of tracheostomy care, which informed a targeted educational intervention to key stakeholders. Future efforts will evaluate the effect and sustainability of this targeted intervention in reducing institutional time to decannulation.