'On the Right Trach?' A review of the care received by patients who undergo tracheostomy.

An National Confidential Enquiry into Patient Outcome and Death (NCEPOD) study published in June 2014 reviewed the care of more than 2000 patients who had a new tracheostomy formed during an 11-week period in 2013 in the UK, two thirds of which were inserted at the bedside in a critical care unit. Many more patients in hospitals now have a tracheostomy, and this article summarizes the lessons from the report which are particularly important for secondary care clinicians.

Are we 'on the right trach?' The National Confidential Enquiry into Patient Outcome and Death examines tracheostomy care.

OBJECTIVES: The National Confidential Enquiry into Patient Outcome and Death presents a detailed survey of practice, encompassing the care pathway for patients with a new tracheostomy formed in hospital, alongside a review of organisational aspects of care. RESULTS: Tracheostomy formation has come to be regarded as a relatively low-risk procedure that can be carried out safely at the bedside, even in high-risk patients. Information on how many procedures are carried out percutaneously has been poor and not captured by existing UK data collection systems. CONCLUSION: The study reinforces recommendations made by other healthcare groups, and presents new information which can be used as a basis for discussion and future planning to improve patient outcomes. The importance of meticulous ongoing care of a tracheostomy is recognised as important to prevent patient complications. Bedside staff must have the knowledge, competencies and confidence to deal with common and potentially life-threatening emergencies when they occur.

The management of trauma victims with head injury: a study by the National Confidential Enquiry into Patient Outcome and Death.

INTRODUCTION: In 2006 the National Confidential Enquiry into Patient Outcome and Death undertook a large prospective study of trauma care, which revealed several findings pertaining to the management of head injuries in a sample of 493 patients. METHODS: Case note data were collected for all trauma patients admitted to all hospitals accepting emergencies in england, wales, Northern Ireland and the Channel Islands over a three-month period. severely injured patients with an injury severity score (iss) of ≥16 were included in the study. the case notes for these patients were peer reviewed by a multidisciplinary group of clinicians, who rated the overall level of care the patient received. RESULTS: Of the 795 patients who met the inclusion criteria for the study, 493 were admitted with a head injury. Room for improvement in the level of care was found in a substantial number of patients (265/493). Good practice was found to be highest in high volume centres. The overall head injury management was found to be satisfactory in 84% of cases (319/381). CONCLUSIONS: This study has shown that care for trauma patients with head injury is frequently rated as less than good and suggests potential long-term remedies for the problem, including a reconfiguration of trauma services and better provision of neurocritical care facilities.